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� 1� � ' <br /> 1 1�I <br /> ;' �� , � � ��A��+� �t��1NTY, �L�I�IDA <br /> � , ; . . <br /> � ;x _ . � , / �� . <br /> � .• _� � . Permit No. <br /> Date Permi�ted � � <br /> Buiider Name/Owner Nam�e S(..JG�i� <br /> , �-�� .��. Gontro!# ' <br /> Count Parcef No. ��-?-�--2f-6Zf Q—C7�GY�^ �pC1'L SubDlv: Lt�G�[�.����E? <br /> v . . <br /> )'`irCcJ`rt i-C'.. �-� � �'Q <br /> Addressii�acatiori �7�0� _____�'� �`d <br /> ClassificationfFype of Use �^��'l ��'��-. ~ - _ _ :'� . . . <br /> _,._.._ t__= _._. <br /> TRANSPORTATt01� lMPA�T FEE , Rate: � Sq Ft Unit; f��� <br /> Exempt � [] Yes [] No NoW Determined � <br /> ' impact Fee Amaunt � ��i �Z� � Zone Na. T�� <br /> SCHOt3L iMPACT�EE � . <br /> Account (056) Single-Family Qetached House AmQUnt $ , J�� <br /> � ' (057) Mobile Hame , . . <br /> , (058) Other Residentiai � , . <br /> . '!23) Go!lectio� �ee <br /> Exempt [� Yes [� No How t�etermined <br /> PARKS AND RECR�ATIdN FEE � � _.• <br /> Land Accaunt � Land C�edit Land Tatai _ ,_ _ <br /> Recreation Account � Recreatlon Gredit Rect-eatl�n Total <br /> Zone � ' TOTAL AMOUNT $ 7��° �� <br /> Exempt ❑ Yes ❑ N� How Determined <br /> �,1BRARY F�E � � � � <br /> �.and Account I�and Credlt Land Totat <br /> Faciiity Account Faciljty Credlt Facility Total . <br /> Exempt ❑ Yes ❑ Na How Determined • Totat Amount � <br /> RESOURCE FEE � ERU ` � <br /> TOTAl�AMOUNT � <br /> Prepared 8y � Checked Ry <br /> NO CERTIPlCATE OF OGCUPANCY tNILl. BE iSSUED �R FiNAL INSPECTiQN <br /> PERfinRMED UNTIi,THE TOTAL AMOUNTS LISTED HAVE <br /> , BEEN PAID A�lR <br /> REG�lPTED FOR BY A CENTRAL PERMITTING OFFICE.UF PASCO COUNTY <br /> Acknowledgement belaw doas not imply accaptance of concurrenca,but simply recelpt of a copy of thls form,piacln� <br /> the bu!!ding permlt ownac on nat4ce af thfs assessmen#and th�cond(tians pf pa�rment for same. <br /> . , <br /> pATE R�CEIVER BY <br /> RECElPT NO. DATE 8Y <br />