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__ <br /> � <br /> I � <br /> ► . <br /> ; . <br /> :'� '. <br /> � ; �� . �� � P,A�C+�3 CQ�Ii�T�', �`L+C�i�IDA <br /> . . ; , . <br /> . . � � . � � . <br /> � • � ' • Permlt No. _���_� <br /> � Date P�rmf�ted �i -1'1�'t� , <br /> Bullder NamelOwner Nam�e ��d1 �t(%`N� �� Control# �. . <br /> � � � / . <br /> Gounty Paccei Na.�v�'�- 2f�--t)�'L�(�-l}�?�(��-��.C� SubDiv: Q(�ttc r <br /> AddresslLocat�Qn �7�'3 2 ��r'(�f��'���..� � ���-� !-'�`5�7 ' <br /> f :�.-��,_�_�f j ,� <br /> Glassificationll'ype af llse ��h f2o'Y►�� ';. - _ <br /> � J �' <br /> TRANSPORTATION IMPAGT FEE , Rafe; I � � Sq Ft tlnit; fi ��.� <br /> Exempt ❑ Yes [� No How Determin�d � <br /> ' Impact Fee Amount �►. c.�fp 3 z•d2� Zane Na. TAZ: <br /> SGHt3�L 1111tPACT FEE � <br /> Account �056} Single-Fami{y Detached Housa Amount � �l�'". <br /> (057) Mabfls Nome ' . . � <br /> , {058) Other Reslder�tiat , <br /> 123) Coll�ctio� Fee <br /> Exempt [� Yes [] No How Qetermfned <br /> PARKS AND RECR�ATION �EE � �. <br /> Land Accoaunt � t�and Credit L.and Total <br /> Recreatian Account � Rec�eatiort Credlt Rec�eation Tota! <br /> Zane �� TOTAL AMC)UNT $ � C��'•�� <br /> Exempt ❑ Yes [] No How Determine � <br /> LIBRARY FEE � � ' ' <br /> l.and Account �.and Credit ( L.and Total ' <br /> Facility Account Facillty Credit I Facllify Total <br /> �� . .. � . <br /> Exempt [� Yes ❑ Na Mow Determine i . Tofal Amount � <br /> RESOURCE PEE I � ERU � � <br /> ! Tt�TAL AMOUNT � � <br /> i <br /> Preparad BY � Checked py. . <br /> �� N� cERT��ICATE oF occuPANCY WILt, BE iSSUED oR FINAL INSPECTIQN <br /> � PERFORNiED UNTtL TNE TOTAL AMOUNTS LiSTED HAVE . <br /> . BEEN PAiD AND <br /> RE+CEIPTE� �C�R BY A CENT�tAL PERMiTTiNG t,�FFiCE��� PASCO COUNTY <br /> _ i <br /> Acknowledgement below does nat impty acceptance�f canc►�rrenoa,but slmply recelpt af a copy of this farm,piactn� <br /> fhe buliding permit awner on notice of thls assassment and thQ conditians pf paXment for same. <br /> , <br /> G . <br /> � , <br /> � DATE R�C�IVER BY <br /> RECEIRT NO. DATE i By <br /> • , . <br /> i <br /> , I <br /> i - �- -- -- <br />