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� � § <br /> �: P���4 COLJNTY, IFLORIDA <br /> "�' Permit No. �`(! �� <br /> Date Permitted � D� cSr <br /> Builder Name/Owner Name �-�i(�1.� � Control# ' <br /> - <br /> County Parcel No. D�?�-?��D�(oU��D�OC�-P3Z� SubDiv: 5� �U`Qr�C� <br /> . <br /> Address/Location 3� �� �i O��U ���'�"� �� ���Z-Z- � <br /> Classification/Type of Use __�'�ytG/Q ����i <br /> � <br /> TRANSPORTATION IMPAGT FEE , Rate: Sq Ft Unit; 2�3 4,L <br /> Exempt � Yes � No HoW Determined <br /> ' Impact Fee Amount $. �(�,�3Z� Zone No. TAZ: <br /> —� <br /> SCHOOL IMPACT FEE � � <br /> Account (D56) Single-Family Detached House Amount $ ���(p• � <br /> (057) Mobile Home <br /> , (058) Other Residential � � <br /> 123) Collection Fee <br /> Exempt Yes [] No How l7etermined <br /> PARKS AND RECR�ATION FEE � �' <br /> Land Account Land Credit Land Total <br /> Recreation Account Rec�eation Credit Recreation Total <br /> Zone TOTAL AMOUNT $ ��a��,6 <br /> Exempt � Yes � No How Determined � <br /> LIBRARY F�E ' <br /> Land Account L.and Credit Land Total <br /> Facility Aocount Faciljty Credit Facilit'y Total <br /> Exempt � Yes � No How Determined Total Amount �— <br /> RESOURCE FEE ERU ' � <br /> TOTALAMOUNT . <br /> Prepared By '�' Checked Sy <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTIQN <br /> PERFORMED UNTIL THE 707'AL AMOUNTS LISTED HAVE <br /> F2ECEIPTEb FOR BY q CENTRAL P RMIT'TING OFFICE.OF PASCO COUNTY <br /> Acknowledgemant helow does not Imply acceptance of concurrenoe,hut simply recelpt of a copy of this form,placing <br /> the bullding permit owne�on notice of this assessment and th�condltlons of payment for same. <br /> QATE <br /> R�CEIVER BY <br /> RECEIRT NO. �_ pATE gY <br />