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, <br /> � �•, . <br /> ��• '�, <br /> �' PAS�Q► COUNTY, �LC�RID,A <br /> � <br /> i. . <br /> .. . Perrnit Na. 1 �R 7 � <br /> ( Date Permitted � - �r--� <br /> � � <br /> Builder Name/Owner Name �_ ��`Yt< G4'7 �-�Contro! # <br /> �- � / .�--.. <br /> Caunty Parcel No. � ��-lP`2�—�j2 l�—,(�0 Dt�L�—D�.�'DSubDiv: (��llL�..� �Qr'vl�...� <br /> Address/Location � � v't � �Y-�.t.`'r�`�- ���--L--� �`�� � <br /> I <br /> Classification/Type of Use��(1. ��ir✓�.. <br /> TRANSPCIRTATIC►N IMPACT FEE Rate: Sq Ft Unit: � � ��� <br /> � Exempt [] Yes [] No How Defermined <br /> �1 f <br /> impact Fee Amaunt $�-t�� � Zone No. TA2: <br /> i <br /> ' SCHQC?L tMPACT FEE � , <br /> ' Accaur�t (056) Singie-Family Detached House Amoun# $ _ <br /> (057} Mabile Hame ( <br /> � (058) Other Rssidentlal <br /> ' 123) Collection Fee . I <br /> I Exempt [�] Yes [� No How Determ�ned <br /> � <br /> , PARKS AND REGREATIQN FEE ; <br /> Land Accaunt l.and Credit � Land Total � � <br /> ' � <br /> Recreation Account Recreation Credit Recreation Total <br /> � � <br /> Zon� �, TOTAL AMOUNT $ � F�q` �!a <br /> �� Exempt ❑ Yes ❑ No How Determine i <br /> LIBRARY FEE ; <br /> Land Accaunt Land Credit ' Land Total <br /> Facility Account Facility Credit li Facility Total <br /> � <br /> Exempt � Yes � No How Determinetl T�tal Amaunt <br /> i <br /> RESOURCE FEE ' ERU <br /> TOTAL AMOUNT <br /> I <br /> Prepared By � � iChecked By <br /> N4 CERTIFICATE OF OCCUPANCY WI�L. �E ISSUED O <br /> R �iNAL INSPE�TION <br /> PERFC}RMED UNTl�.THE T4TAL AMOUNTS llSl'ED NAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMITTING QFFICE QF PASCt� COUNTY <br /> Acknowledgement below does not Imply acceptance of concurrence,but simply receipt of a copy af this form,placing <br /> the building permit owner on no#ice of this assessment and the conditions of payment far same. <br /> DATE REGEfVED BY <br /> RECEIPT NO. DATE ' BY <br /> � <br />