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i <br /> E � <br /> .'t <br /> �-n•,. '�, <br /> PASCC) C(�UNT�, FLC)RID�► <br /> x`Y' i`'• - � � <br /> , . ( Permit No. � � � � �� <br /> � � <br /> � <br /> Date Permitted �-��-- I�S ; <br /> Buiider NamelOwner Name �i � ��'��`n ��ontrol# <br /> ! -- <br /> County Parcei No. f�-2-�i - 7.( -���,�- �C��-U +��SubDiv: ���/t.LC.� .(�Q��'i,t� <br /> i <br /> AddresslLacation <br /> 3 � C? �--V r't�r�`t'� ��� � 1.._7``�-{ � <br /> t�� �� <br /> ClassificationlType af Use ' C�t�t�..�t� <br /> TRANSPORTATlON IMPACT FEE Rate: Sq Ft Unit: �t�(�'�_ <br /> Exempt [] Yes [� No How Determined <br /> Impact Fee Amaunt $ ����C�� Zone Na. TAZ: <br /> SCHOOL IMPACT �EE ! <br /> Account (Q56) Single-Family Detached Ho ise Amoun# $ <<�� <br /> (q57} Mobile Home <br /> (058) Other Residentia! <br /> 123} Cailection Fee j � <br /> Exempt � Yes [] No How Oetermined � <br /> I <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit i l.and Tatal <br /> � <br /> Recreation Account Recreation Credit Recreatian Totai <br /> ; <br /> Zone I TOTAL AM4UNT $ 7�p�r � � <br /> I � <br /> Exempt [� Yes [] No How Determine'I <br /> LIBRARY FEE j <br /> Land accaunt Land Credit � Land Tatal <br /> Faciliky Accounk Facifity Credit ; FacHity Totai <br /> � �,/ <br /> Exempt ❑ Yes ❑ No How Determine� Totai Amount �-�1 <br /> � <br /> RE�OURGEFEE � ERU <br /> TC3TAL AMaUNT I <br /> I <br /> � <br /> � ' <br /> Prepared By � ;Checked By <br /> I � <br /> NQ GERTIFtCATE OF OCCUPAN�Y WIt.L BE ISSUED OR F1NAL INSPECTION <br /> PERFORMED UNT1L 7NE 70TAL AMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECElPTED Ft3R BY A CENTRAL PERMITTING OFFtCE OF PASCO COUNTY <br /> Aeknowledgament belaw does nat fmpiy acceptance of cancurrence, but simply receipt of a capy of#his form,placing <br /> , the building permit owner on natice of this assessment and the candi#ions of payment for same. <br /> I <br /> ', DATE RECE{VED BY <br /> �, � <br /> RECEiPT NG. DATE BY <br />