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...._ ...-.--- `,�\ \ <br /> I <br /> ,�� <br /> �ry+ I <br /> ��ASCC� ��l1NTYy FL,C�i�1�,A <br /> Mo�.:� , <br /> * !. <br /> " .. ' Permit No. -�f,,�Q�/� <br /> � Date Permitted �--:�-�..�""' <br /> � ; <br /> Builder Name/Owner Name R� C,�- �: Control# <br />, � <br /> I � ��',�'I?�. <br /> Caunty Parcel No. f��—�(�Z-j0 —Q � �(Z�f��_ SubDiv: � � <br /> Address/Lacation ���-� rp �i''G�.i Y)�,. ��3�2 �-� �.� �' �,J <br /> !�, � <br /> Classification/Type of Use ���r1. �' t$Y�-�,°t�.� <br /> TRANSPO►RTATION IMPACT FEE Rate: i Sq Ft Unit: � �3 <br /> Exempt [] Yes � Na Now Determined <br /> Impact �ee Amount $ ��-�'j�} . Zane Na. TAZ: <br /> SCHOC?L tMPACT FEE ; �-�y- <br /> Accaunt ((}56) Single-Family Detached Hou'se Amount $ `'t"J <br /> (Q57} Mobile Home ' <br /> {058) Other Residentia! <br /> 123� Collection Fee <br /> Exempt [� Yes [� Na How Determined <br /> I <br /> � <br /> PARKS AND RECREATlON FEE I <br /> Land Account Land Gredit I l.and Tata) <br /> i <br /> Recreation Accaunt Recreation Credit Recreation Total <br /> � <br /> Zone � TOTAL AMOUNT $ 7��-�—=�`,�"��� <br /> Exempt � Yes [] No How Determined <br /> LIBRARY FEE I� <br /> Land Account Land Credit , Land Total <br /> � <br /> I Facility Account Facility Credit ' Facility Total <br /> Exempt ❑ Yes ❑ No How Determined Total Amount ,���� <br /> � <br /> RESOURCE FEE I ERU <br /> T{�TAL AMOUNT � <br /> � <br /> � <br /> Prepared �y ' �Checked By � <br /> � <br /> � <br /> NC? CERTlFICa1TE OF OCCUPAN�Y Wit'� BE ISSUEd OR FINAL INSPECTiON <br /> PERFdRMED UNT!!.TNE 7UTAL AMOUNTS LiSTED HAVE <br /> BEEN PAfD AND <br /> RECEIPTED FOR BY A CENTRAL �'ERMIT`TING +QFFlCE O� PASGt? GOUNTY - <br /> Acknowledgement beiow does not impty acceptance of concurrence,but simply recelpt of a copy of this form,placing <br /> the buiidfng perinit owner on notice of this assessmant and the conditions of paymenf for same. <br /> DATE RECEfVED BY <br /> RECEIPT NO. DATE BY <br />