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•�i <br /> '`'�7i �'r <br /> ;� : P'AS�C� C�Uf�T'Y, �LC���CtA <br /> .;;.� <br /> : <br /> r <br /> ��� � Permit No. � �P � !� <br /> Date Per'mitted��,�/--lcS�" <br /> Builder Name/Owner Name �' : h.. � r�l�i � Control # <br /> County Parcel No. ��~—�(c�—ZJ—O�(�p—bG�:3�t��� �? �9 SubDiv: �����?� <br /> Address/L.ocation ��O�Z� ��� IJr��`�' �1�'� � <br /> Classificafion/Type of Use S► !{ ���1 C- <br /> TRAN5Pt3RTATiON IMPACT FEE Rate: Sq Ft Unit: �G'1j�� <br /> Exempt [] Yes �?No Haw Determinad <br /> Impact Fee Amourtt $���4j,�' Zone No. TAZ: <br /> SGHOOl. IMPACT FEE � �!` 1, � <br /> Rccount (Q56} Singie-Family Detached Nouse Amount $ �! S{� ��Z) <br /> (057} Mabile Home <br /> (058) (ather Resfdential <br /> 123} Callection Fee � <br /> Exempt (� Yes �lo How Determined <br /> PARKS AND RECREATl�N�FEE <br /> Land Account Land Credit Land Tota! <br /> Recreation Account Recreation Credit Recreation Tatal <br /> Zone TOTAL AMOUNT $ ���jd�� <br /> Exempt [� Yes [] No How Determined <br /> LIBRARY FEE <br /> Land Account Land Credit Land Total <br /> Facility Account Faciiity Credit Facility Total <br /> Exempt ❑ Yes ❑ No How Defermined Total Amount � <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT <br /> Prepared By � ��� ' Checked By . <br /> NO CERTIFICATE OF OCCUPAN�Y WILI, BE tS�UED OR FiNAL INSPECTi01� <br /> PERFORMED UNTIL THE 70TA�. AtN4UNTS LiSTED HAVE <br /> BE�N PAtD ANCt <br /> RECEIPTED FOR BY A CENTRAL PERMITTING QFFiCE OP PASCO COUNTY <br /> Acknowled ement below does not im I acce tance of cancurrence,but sim I recelpt of a copy of this form, lacing � <br /> 9 PY P PY P <br /> the building permit awner on notice of this assessment and the conditions of paymenk for same. , <br /> DATE RECEIVED BY <br /> RECEIPT N4. DATE BY � <br />