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--— - ! _ <br /> � <br /> . I <br /> _ . . <br /> , <br /> ;� �„ <br /> � � � , -� `; p ��� �QUNTY, �Lt���DA <br /> , �► . <br /> � . <br /> '� Permlt No 1 ��� <br /> �:..,. . • <br /> Date Permi�#ed �b � � <br /> r /� �� ���'�y�°t� Cantraf# �. . <br /> euifder Name/Qwner Name �� .� � <br /> , <br /> (� _Z(�_�j�-p D bD—c�2�d�; sub�iv: �� (�?�C�f� <br /> Gounty Parcel No. , <br /> ,r a� �?lu�� �- � �-�� �� � . <br /> Address/Lacation .� T`� �S� � , <br /> Classification/Type ofi Use <br /> �,Pa�'�`�'.�,..`��� ���. � ��'n' l <br /> TRANSPORTATIC3N 1MPACT FEE � Rate: I � Sq �t lJnit; �� <br /> � <br /> Exempt ❑ Yes ❑ No HoW Determined ( � <br /> ' lrnpact Fee Amount �. ����` �� Zo e No. ' T�: <br /> � ( - <br /> SCHOOL IMPACT FEE ' �,� <br /> Account (056) Singie-Fami{y Datached House Amat�nt $ �� ��►. � <br /> ' (05T) Mobile Home . � , <br /> , (058) tither Resfdentla! . <br /> 123} Caiiacfiop Fee <br /> Exempt � Yes Q No How Determined <br /> ( <br /> FARKS AND RECR�ATlC1N �EE � � <br /> Land Account ' Land Ctedit � Land Totai <br /> Recreation Accaunt • Rec�-eation Credit Recreation Totai <br /> Zane . TOTAL AM4UNT $ ��P�r�S� <br /> Exempt ❑ Yes [] N� How Determ{ned <br /> L18RARY�EE � � � ' � � . <br /> �and Accoun# l.and Credit Land Tota(. � <br /> Facility Accaunt Faciijty Credit ( Faciiity Total <br /> Exempt ❑ Yes ❑ No How Determined � Total Amaunt �`C"/ <br /> - _1 <br /> RESOURCEFEE � ERU ` � � <br /> TaTAL AMOU�IT � ' <br /> . � . . <br /> Prepared By t Checked �y <br /> NCf CERTIFICATE OF OCCUPANCY W1LL BE 15SUED OR FINAL lNSPEGTIQN <br /> PER�ORNlED UNTl�THE TOTAL AMC3UNTS lISTED HAiIE <br /> . BEEN PAID AND � <br /> R�C�iPTED Ft3Ft BY A CENTRAL PlERMlTTlN�3 Q�PICE�UF PASGO GOUNTY - <br /> � <br /> Acknowiadgement below daes not lmply acoeptance of conc Irren�e,but slmply reaelpt af a copy af thfs farm,plactng <br /> - ihe building permlt owne�on c►otice nf thls assess ' ent and th�conditlflns pf payment for sama. <br /> . , . <br /> pATE R�CEIVEp� BY <br /> R�CEiRT N�. DATE BY <br />