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BUILDING
'1~ ~/(,
ELECTRICAL
(813) 780-0020
61,50 35' ~
PLUMBING MECHANICAL
Property Owner:
7h
Sewer Conn /,...... )
Water Conn: C ~".ti.:;! (~fi1j
Water Meter: /8'0' p:;o
FINAL
,..J D
Job Address: /11
ParceII.D." 03-:2'-.;1/-0 -6JPO:?O-9t9rO
Zoning: Ene!gy Code: ~,d:~ ~as: ,v. 63'
Descriotion of Work 0~o& rtJl.f11; I; ~
NO OCCUPANCY BEFORE C.O.
Complete Plans, Specifications and Fee Must Accompany Application. C.O.
All work shall be performed in accordance with City Codes and Ordinances.
Inspector
"".'m;t Fee~
,.>sIgnature
Company
Address
~elephone# ~~t6X-7
ao~8tr JllfV'
/Irs! ~SS r!'/ec. ~Se7'I/.. , Sohn7's H.:Jo'
IF /'I~' . f:7
ELECTRICAL PLUMBING ~ MECHANICAL
Valuation or
Contract Price
$13/ tJ;2/J. tJft
I
187
City License Registration #
State Certified License#
~~~
BUilDING
~O"
Ftrl .; IJ -l7-o;2. j!<.'f Tp. Servo
Pre SLB ~/7-;2& -eJ;2 /I'JO Rough In t.-A~3t1''''8''LIl(.~
. ,..fC
Lintel Meter Can J
FRM. /r -2 ~_ t:2 1(.::1(.1 Const. Pole .; y... H-.()2 f4f3
Insul. CL ~/ 9-.2?- -02 I/!f6 Pool
Wl ,,/ 9-~--Cl.;2..t/:JO Pre-Meter i///-1-t/2 IZL~
Final
Driveway ~tf\ry U -=
5!'lu.-tit,~'r FP g-IS-(l~ ]:o1J 7~/7-/;Z6d;~r ~IJ ~Jr=-
REINSP!fCTION FEES: When extra inspection trips are necessary due to anyone of the following reasons, a
charge of twenty-five and 00/100 Dollars ($25.00) shall be made for each trip for each trade:
FP 11- Lf-tJv1- /J1/;-'rcJ/) g':;2 <( /Lr~ ~.
a. Wrong Address j A
b. Condemned work resulting from faulty construction. .' \d ~
C. Repairs or corrections not made when inspection called. .
d. Work not ready for inspection when called. :9:!-'/'
e. Permit not posted on job site.
f. Plans not at job site.
,/ ....--
g. Work not accessible. ~~.-
SLB .~ ~ 0:2 /-Iyo Breakers
Tub Set ~::> h~'t)') Wl> Ducts Ins!. ~r.;LC.-tt"2- 115"0
wateq:;! -.26 ~tJ::l;tfC Compressor
Sewer /~ <j!-tJ ~ (<.Ll(.lf.fi~al
Final
The payment of inspection fees shall be made before any further permits will be issued to the person owning
same.
Gold Medallion Homes
Tract "F" Unit 2
SQ. FEET PRICE
MAIN OR LIVING: 1,020 $ 40.00
OTHER AREA UNDER ROOF: 148 $ 15.00
OTHER: $ -
VALUATION $ 43,020.00
FEE SHEET $ 240.00
ADDRESS $ 20.00
DRIVEWAY $ 20.00
BUILDING: $ 400.00
CREDIT: $ -
BUILDING LESS CREDIT: $ 400.00
ELECTRICAL: $ 76.16
PLUMBING: $ 67.50
MECHANICAL: $ 35.00
RADON: $ 11.68
TOTAL $ 590.34
SEWER: $ 1,278.00
WATER: $ 350.00
IRRIGATION: 1$ -
TOTAL: 1$ 1,628.00
WATER METER: I $
IRRIGATION METER $
180~OO I
SUB-TOTAL $
2,398.34 I
SIPS: $ 1,694.00
97.5% $ 1,651.65
2.5% $ 42.35
I
J
T IF'S 'I $
99% $
1% $
: I
TOTAL: $
4,092.34 I
-,
, .'
(-)
'- /
''''''-'''~
PASCO COUNTY, FLORIDA
Permit Nu. _
t .~"~'f I ~-;.~.~
Date Permitted
','
.'";ti.")
1-...
....~..f <...".;;,4-
Builder Name/Owner Name : ':'d"( f
I
f f LJ i l : ~., LLct ' '. r. ; I \k. J
~L r\ (
'r~ (-
County Parcel No. ., ". ,. .. _,' 01 no ~ --:; rot'J(~ - ,
Address/Location 'G"i I .;.2
Classificationffype of Use
'\", --"," - ," ,';,;
, - I ....t:m "'''.!. .<...1 Y/ r
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iT ~.-
Subd.
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(]
How Determined
TRANSPORTATION IMPACT FEE CALCULATION
EXEMPT 0
Why?
Rate $ ,
Zone No.
Sq. FtlUnit
Prepared By
Impact Fee Amount $
Checked By
The above impact fee has been established pursuant to the Pasco County Transportation Impact Ordinance as adopted by the
Board of Pasco County Commissioners. This amount is payable PRIOR to the issuance of a Certificate of Occupancy or
utilization of the permitted structure.
RESOURCE RECOVERY ASSESSMENT
EXEMPT 0
RESIDENTIAL
NONRESIDENTIAL
No. Units
I
Gross Sq. Ft. (GSF)
Rate ERU -
54.00Near
or $0. 148/Day
ERU Assign No.
Assessment -
(No. Units) x ($0.148)
x (No. Days)
.It'"' , '95
Assessment -
(GSF) x (ERU) x (0.148) x (No. Days)
100
TOTAL FEE $
TOTAL FEE $
.-J__---7
/
L./'"
1J;{s
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/ l' .
l~{_/ "Cl
I
NO CERTIFICATE OF OCCUPANCY OR FINAL POWER RELEASE WILL BE ISSUED UNTIL THE AMOUNTS LISTED
HAVE BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY.
Acknowiedgement below does not imply acceptance of concurrence. but simply receipt of a copy of this form. placing
the huilding permit owner on notice of this assessment and the conditions of payment for same.
Date
Received By
OFFICE USE ONLY
TRANSPORTATION REC. NO. DATE
RESOURCE RECOVERY REC. NO."5 ~ ':~, j 0 (/ DATE
BY
It:) J c Jl~- BY
/1-.)/ "
I Aoo"':')
"r ,.. ,
While
Applicant
Canary
Trans/Finance
Canary
RR/Finance
Pink
Office
Green
Bldg/lnsp
feecal:ce
PC93113094/E
CITY OF
ZEPHYRHILLS
"NOTICE"
OF ADDITION OR CORRECTION
BUILDING
DEPARTMENT
DO NOT REMOVE
DATE PERMIT ."
'Ctv... q;~1 i- 02.., /3/ -J. / S
THIS JOB HAS NOT BEEN COMPLETED. T~e following additiqns or corrections shall be made before the job
will be accepted.
~~Tr1~ kJl~l~cld~~)
Y~~~~~~d
OFFICE HOURS 8 - 5 MON.-FRI.
. AFTER CORRECTIONS ARE MADE CAlL
788-6611 FOR RE-INSPECTION
tNSPECTOIl W
" is unlawful tor any Corpenter, Contractor. Builder. or other persons. 10
cover or caUM to be covered, any port of the work with flooring. loth, earth
or other material. untlllhe proper Inspeclor hal hod ample time to approve
the Inltallatlon.
1/aeei4 Seevice Un&mited, gnc.
~
J I 16 002 P.o. BOX 2304
U Y , 2 DADE CITY, FL 33526
(352) 521-0707 FAX (352) 518-0000
LARRY D. HARRIS
To: City of Zephyr hills
Building Department
Re: Removal from jobs
To Whom It May Concern:
Please be advised that Harris Service Unlimited, Inc., located at 15752 Hwy 301 N.,
is requesting to be removed from the permit numbers and address sights listed below:
Permit # 1315
Address: 6208 Moorfield Ln.
Permit # 1313
Address: 6212 Moorfield Ln.
Thank you for your help in this matter.
APPLICATION FOR PERMIT
CITY or ZEPHYRHILLS
. BUILDING DEPARTMENT
DATi!: lU!:Cl!:IVJm,;2 - -;) 7 -- () ::J-
PLANS REVtn nz
OWNER'S NAME
JOB ADDRESS
LEGAL D~SCRIPTION: LOT(S) -;;;--ct-iY:::" BLOCK ~krtfxk~ /Ir/tc;-c(
I'ARCEL ID H /)3 .- Jk-:J1- () :>tJ[)- ('JLVilr- (6f7J 10BTAIN FROM PltOPERTY TA~ :OTt: I
WORK PROPSED: 1NEW CONSTRUCTION 0 ADDITION OALTERATION 0 REPAIR tl iNSTALL
DSIGN 0 MOVE 0 DEMOLISH
PROPOSED USE: J6SGL FAMILY DWELLING OMULTI-FAMILY 0# OF UNITS
10 COMMERCIAJ... 0 INDUSTRIAL 0 SWIMMING POOL
ti MOBILE HOME
o OTHER
DESCRIPTION OF WORK
c:J RESTAURANT & HEALTH DEPARTMENT APPROVAL
~?V~
BUILDING SIZE
JO '.'f. to
SQUARE FOOTAGE
j(l:J-O
.
~~~
HEIGHT
RESIDENTIAL:
COMMERCIAL:
ATTACH (2) PLOT PLANS & (2) SETS OF BUILDING PLANS & (1) SET ENERGY FORMS.
ATTACH (3) SETS OF BUILDING PLANS & (1) SET ENERGY FoRMs.
PROPERTY SURVEY REQUIRED FOR ALL NEW CONSTRUCTION.
PERMITS REQUESTED
ft
rf" BUILDING
r,(j ELECTRICAL
~ PLUMBING
~ MECHANI CJ\.L
6 GAS 0 ROOFING
$
~ oz;V
I~o
VALUATION OF
AMP SERVICE rI
TOTAL CONSTRUCTION
FLORIDA POWER 0
W.R.E.C.
$
o SPECIALTY
VALUATION OF MECHANCIAL INSTALLATION
o OTHER
FINISH~D FLOOR ELEVATIONS
! FMME
o STEEL
o OTHER
TYPE OF CONSTRUCTION: 0 BLOCK
IS PROJECT IN FLOOD ZONE AREAO YES
o NO
BUXLDBIl
COMPANY
STATE CERT OR REGIST #
CITY PROCESSI~' I fJC( .
***************************************************************
COMPANY F ~~. ~ ell Q- C-,",
STATE CERT OR REGIST ti ~ ,:::)002-:;-7 0
CITY PROCES~H / ~ (_
~:;;:.;;""""""'''''''''''''' .,{{,I/; It,:. J,.JN4 {{. fit,.. k ;"1
. --__ ~~ ..,..~c,
PLUMBJUt . . COMP Y L /
STATE OR REGIST " () ~
CITY PROCESSIN~' c~
* * * ** * * ** **.* * * * *** ** * * ** ** * ** ** *** **** ** *** * ***********f***;)t****..,. /" L I
YJl:CHANlCALK COMPANY 5' 0 ~ s _, sCv _ A-N , c4t-
V' STATE CERT OR REGIST" L Ih~ 0 J"''''' f----
SIGNATURE ~ ~ 4I!7~ CITY PROCESSING " 170 Y,
***********************************************~***************
SIGNATURE
OTHER
COMPANY
STATE CERT OR REGIST #
CITY PROCESSING #
SIGNATURE
*************.***************************~****~******~***********
1\.. NV'1'.LI.,;~ U~. DEED RESTRICTIONS
The undersigned understands that this permit may be subject to "deed restrictions~ which
may be more restrictive than city regulations. The undersigned assumes responsibi~ity for
compliance with any applicable deed restrictions.
B. 'UNLICENSED CONTRACTORS AND CONTRACTOR RESPONSIBILITIES
If the owner has hired a contractor or contractors to undertake work, they may be required
to be licensed in accordance with state and local regulations. If the contractor is not
licensed as required by law, both the owner and contractor may be cited for a misdemeanor
violation under state law. If the owner or intended contractor are uncertain as to what
licensing requirements may apply for the intended work, they are advised to contact the
City of Zephyrhills Building Department, 813-788-6611.
Furthermore, if the owner has hired a contractor or contractors, he is advised to have the
cont~actor(s) sign portions of the "Contractor Sections" of this application for which the:
will be responsible. If you, as the owner signs as the contractor, you are indicating thai
you, rather than the contractor, are responsible for the work. If the contractor wishes
you to sign as contractor that may be an indication that he is not properly licensed and ii
not entitled to permitting privileges in the City of Zephyrhills.
C. TRANSPORTATION IMPACT FEES AND UTILITY CONNECTION FEES
D. CONSTRUCTUION LIEN LAW (CHAPTER 713, FLORIDA STATUTES, AS AMENDED)
I certify that I, the applicant, have been provided with a copy of "Florida's Construction
lien Law - Homeowner's Protection Guide" prepared by the Florida Department of Agriculture
and Consumer Affairs. If the applicant is someone other that the "owner", I cerify that I
have obtained a copy of the above described aocument and promise in good faith to deliver
it to the "owner" prior to commencement.
E. CONTRACTOR'S/OWNER'S AFFIDAVIT
I certify that all the information in this application is accurate and that all work will
be done in compliance with all applicable laws regulating construction, zoning, and land
development.
Application is hereby made to obtain a permit to do work and installation as indicated. I
certify that no work or installation has commenced prior to issuance of a permit and that
all work will be performed to meet standards of all laws regulating construction, City
codes, zoning regulations, and land development regulations in the jurisdiction. I also
certify that I understand that the regulations of other governmental agencies may apply to
the intended work, and that it is my responsibility to identify what actions I must take tc
be in compliance. Such agencies include but are rtot limited to: *Department of
Environmental Regulation-Cypress Bayheads, Wetland Areas and Environmentally Sensitive
Lands, Water/Wastewater Treatment
*Southwest Florida Water Management District-Wells, Cypress Bayheads, Wetland Areast
Altering Watercourses
*Army Corps of Engineers-Seawalls, Docks, Navigable Waterways
*Department of Health & Rehabilitative Services, Environmental Health Unit-Wells,
Wastewater Treatment, Septic Tanks
*U.S. Environmental Protection Agency-Asbestos abatement
I also certify that, if fill material is to be used in Flood Zone "A" or "A, etc.", it is
understood that a drainage plan addressing a "compensating volume" will be submitted which
is prepared by a professional engineer registered in the State of Florida prior to permit
issuance. .
A permit issued shall be construed to be a license to proceed with the work and not as
authority to violate, cancel, alter, or set aside any provisions of the technical codes,
nor shall issuance of a permit prevent the Building Official from thereafter requiring a
correction of errors in plans, construction, or violations of any code. Every permit
issued shall become invalid unless the work authorized by. such permit is commenced within
six months of issuance, or if work authorized by the permit is suspended or abandoned for a
period of six months after the time the work is commenced. One 90 day extension of time
may be allowed for the permit with fee charge of $15.00. The extension shall be requested
in writing to the Building Official. An approved inspection must be logged durih~ each six
month period, or the project will be considered abandoned.
WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR
PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT
WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT. JOBS UNDER
$2,500 IN VALUE DO NOT NEED TO RECORD AND POST A "NOTICE OF COMMENCEMENT".
.~
.IGNA~kER OR AGENT
STATE OF FLORIDA /.?
COUNTY OF (fgsrO
The foregoing instrument was acknowledged
Befor, me tlJ.1.s __U day of f?b - , ~~
by l..DJ,ce ~ (~
.~ (name of person acknowledged)
"WhO is personally known to me, or
o who has produced
(type of identification)
~ whoOdid 1did not take an oath.
~Qri\a rn, LJ10d
Signature of person taking acknowledgement
SIGNATURE~C~ "
STATE OF FLORIDA n
COUNTY OF p-a rr''''
The foregoing instrument was ~knowledged
Before me this/~da~of ~ , ~~.
by A..~q ~~
~ (name of person acknowledged)
;-_.0 is personally known to me; or
Owho has produced
. (type of identification)
an~ho Odid Ixftid not take an oAth
~G ff\o.- err; W]j)tf,
Signature of person taking acknowledgment
'52" I;)g AA \AI
Name ty,#' .. ~~~~s.~mm
;~"" - ."~ July 14, 2005
"J"fif..n..~'- BONDED TIIRU TilO'fFAlN /NSUflANCf, INC.
,,"Iii--~r'sJo:,.. Dana M. Ward
j~~;: r'" CO~~~~ISStON II non~R77R FXPIRES
Name typ~. t1.iinted QiJIy 1iI,t2a16ped
--~r.'" ,,~. BONDED THl!U TROY FAIN IHSUQAHCf. INC.
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3 ~ciCLAIN & ALFONSO, P.A.
/'I r O. BOX 4
'\l.~ ",:.. ( DADE CITY, FLORIDA 3352&-0004
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2002095641
NOTICE OF COMMENCEMENT
Rcpt: 597901
os: 0. 00
06/20/02
Rec: 10.50
IT: 0 . 00
Dpty Clerk
STATE OF FLORIDA )
COUNTY OF PASCO )
THE undersigned, as Owner, notifies all parties that improvements will be made to certain real property, and
in accordance with Section 713.13, Florida Statutes, the following information is stated in the Notice of
Commencement:
DESCRIPTION OF PROPERTY:
GENERAL DESCRIPTION OF IMPROVEMENTS:
CI B Home
JED PITTMAN PASCO COUNTY CLERK
06/20/02 04; 3~m 1 of4S2
OR 81< 498'1 PG 4
See Exhibit "A"
OWNER AND OWNER'S ADDRESS:
Lance A. & Tammy A. Smith
6426 Huntington Drive
Zephyrhills, FL 33542
OWNER'S INTEREST IN THE PROPERTY DESCRIBED AS: Simple
CONTRACTORS AND CONTRACTOR'S ADDRESS: Gold Medallion Homes, Inc.
PO Box 1536
Zephyrhills, FI 33539
SURETY (if any) and SURETY ADDRESS: NIA
AMOUNT OF BOND: $ NIA
NAME AND ADDRESS OF LENDER, IF ANY, MAKING A LOAN FOR CONSTRUCTION OF THE
IMPROVEMENTS:
Community National Bank of Pasco County
Post Office Box 639
Zephyrhills, Florida 33539
NAME OF PERSON WITHIN THE STATE OF FLORIDA DESIGNATED BY OWNER UPON WHOM
NOTICES OR OTHER DOCUMENTS MAY BE SERVED:
Community National Bank of Pasco County
Post Office Box 639
Zephyrhills, Florida 33539
IN ADDITION, OWNER DESIGNATES THE 1<'OLLOWING PERSON TO RECEIVE A COpy OF THE
LIENOR'S NOTICE AS PROVIDED IN SECTION 713.13, FLORIDA STATUTES:
Community National Bank
of Pasco County
Post Office Box 639
Zephyrhills, Florida 33539
Larry Hersch
Attorney at Law
Post Office Box 1046
Dade City, Florida 34297-1046
EXPIRATION DATE: June 17.2003
~r:#.
~ 6~
Tammy~
--::>
STATE OF FLORIDA
COUNTY OF PASCO
The foregoing instrument was acknowledged before me this 17th day of June 2002, by
Lance A. & Tammy A. Smith, who is personally known to me ~
~, and who ctMIdid not take oath.
Witness my hand and official seal in the County and State last aforesaid this 17th day of June 2002.
~lm~~h;d
'N TARY UBLIC
...."-'~~" Dana M. Ward
W~~.:~.. MY COMMISSION # DOO38228 EXPIRES
......~ 200S
.~:1 )uly14.
. '.' .ONDED lIIRU TROY fAIN 1NSUilANCf, I~
,FIr..
G}o /"J
}"rl\.': A
Department of Community Affairs _ FLORlOA ENERGY EFFICIENCY CODE FOR BUILDING CONSTRUCTION
FORM 60DA-97 Residential Whole Building Pertormance Method A . CENTRAL 4 5 6
PROJECT NAME:
AND ADDRESS:
BUILDER:
PERMITTING CLIMATE
OFFICE: ZONE: 405060
PERMITNO.~JURISDlC110NNO.:~\ \ \
CK
OWNER:
1. New construction or addition
2. Single family detached or Multifamily attached
3. If Multifamily-No. of units covered by this submission
4. Is this a worst case? (yes I no)
5. Conditioned floor area (sq. ft.)
6. Predominant eave overhang (ft.)
7. Glass type and area:
a. Clear glass
b. Tint, film or solar screen
8. Floor type and insulation:
a. Slab-on-grade (R-value + perimeter)
b. Wood, raised (R-value + sq. ft.)
c. Concrete, raised (R-value)
9. Net Wall type, area and insulation:
a. Exterior: 1. Concrete block (Insulation R-value)
2. Wood frame (Insulation R-value)
3. Steel frame (Insulation R-value)
4. Log (Insulation R-value)
5. Other:
b. Adjacent: 1. Concrete block (Insulation R-value)
2. Wood frame (Insulation R-value)
3. Steel frame (Insulation R-value)
4. Log (Insulation R-value)
10. Ceiling type, area and insulation:
a. Under attic (Insulation R-value)
b. Single assembly (Insulation R-value)
c. Radiant barrier installed (yes I no)
11. Air distribution system:
a. Ducts (Insulation + Location)
b. Air Handler (Location)
12. Cooling system:, .
(Types: central-split, central-:;ingle pkg., room unit, PTAC" gas, none)
13. Heating system:
(Types: heat pump, elec. strip, nat. gas, L.P. yas, gas.h.p., room or PTAC, none)
14. Hot water system:
(Types: elec., natural gas, solar, L.P. gas, none)
15. Hot Water Credits:
a. Heat Recovery (HR)
b. Dedicated Heat Pump(DHP)
c. Solar
16. HV AC Credits
(Use: CF-Ceiling Fan, CV-Cross vent, PT-programmable thermostat,
HF-Whole house fan, MZ-Multizone)
17. COMPLIANCE STATUS: (PASS if As-Built Pts. are less than Base Pts.)
a. Total As-Built points b. Total Base points
I hereby certify tha
compliance with t
DATE: 1- :}..~() t--
pliance with the Florida Energy Code.
DATE:
OWNER AGENT:
-1.
1.
2.
3.
4.
5.
6.
,vI"
~"
r~1 f'
/fIo
7a.
7b.
r (j) )......0 sq. ft.
/ ft.
Single Pane Double Pane
/1./ I, 'is sq. ft. sq. ft.
sq. fl. sq. ft.
R= b , vA! (cond.luncond.)
V A,' C () r (, (cond.luncond.)
Type: e I A 1 (~ (
SEERlEERlCOP: I L' Lei)
Capacity: :J..1. II (.' (;
Type: !'-I ~ .
HSPF/COP/AFUE: '1. (../
Capacity: 'i). I..{ Oc,J 0
Type: F'fl
EF: i q (
11a.
11b.
12a.
12b.
12c.
13a.
13b.
13c.
14a.
14b.
15a.
15b.
15c.
16.
c f
~7.
17a.
J
17b.
'b (?~
p.} S ~
,
, q- '1
Review of plans and specifications covered by this calculation
Indicates compliance with the Florida Energy Code. Before
construction is completed, this building will be inspected for
compliance inaccordanc ith Sec' n 553.908, F.S.
BUILDING 0 F1CI L:
DATE:
Revised 1998
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III
PASCO COUNTY, FLORIDA
Permit No. I? 13
Date Permitted ~ -;ZS~ 0 ~
Builder Name/Owner Name tJeI..cf ~~J1{~"n ~ Control #
County Parcel No. 03 -;{.It - 2( -D 2-.00-00000 -- D<!:JF 0
Address/Location. 02\?-.. ~f)';..~Ycl j,>0.
ClassificationlType of Use <Res; ~ S \~
TRANSPORTATION IMPACT FEE Rate:
SubDiv: s; I\lev O~ 'S Vi l (~
tC~
+-c 0-
Sq Ft Unit:
Exempt GJYes 0 No
How Determined
Impact Fee Amount $
Zone No.
TAZ:
SCHOOL IMPACT FEE
Account (056) Single-Family Detached House Amount $ -!j {"t1.L/
(057) Mobile Home
(058) Other Residential Pd. 11_ (1--0; 'q
J.:l23) C2!)egtion Fee ~. \~1jSL{
Exempt U Yes lJ-'f'Jo How Determined
PARKS AND RECREATION FEE
Land Account Land Credit
Recreation Account
----------
Zone _________ TOTAL AMOUNT $
~
~.~ 0 Yes 0 No How Determined
Recreation Total
LIBRARY FEE
Land Account
Land Credit
Facility Account
Facilit
Facility Total
--
----
Exempt _....D-~ No How Determined
-------'~"....
Total Amount
RESOURCE FEE
TOTAL AMOUNT
10.'15
ERU
Prepared By
m~ -~ Checked By
,
NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
BEEN PAID AND
RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
Acknowledgement below does not imply acceptance of concurrence, but simply receipt of a copy of this form, placing
the building permit owner on notice of this assessment and the conditions of payment for same.
DATE
RECEIPT NO. S-8""'fj-/CJ(/. DATE
RECEIVED BY
/O~~2 BY
v ~