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,..r�� _ '•, <br /> F'�4SC0 COl1NTY, FLORIDA <br /> ;� . <br /> Permit No. � <br /> Date Permitted <br /> Builder Name/Owner Name �l� ����GC�G � - <br /> County Parcel No. �-�-Z,�.jf��.��..�3� SubDiv: <br /> � ���..� J <br /> Address/Location '7(� 9 ��1� �`�//' <br /> Classification/Type of Use �.2` �,., ' � ' <br /> � �`'l r <br /> TRANSPORTATION IMPACT FEE Rate: Sq Ft Unit: �� <br /> Exempt [] Yes [] No How Determined <br /> � Impact Fee Amount $ �rj 3. 2,� Zone No. T,c�; <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $ <br /> (057) Mobile Home - � � <br /> (058) Other Residential <br /> 123) Collection Fee <br /> Exempt Yes [I No How Determined <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation Total <br /> Zone TOTAL AMOUNT $ <br /> Exempt [] Yes [] No How Determined 'r <br /> LIBRARY FEE <br /> Land Account Land Credit Land Total <br /> Facility Account Facility Credit Facility Total <br /> Exempt � Yes � No How Determined Total Amount <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT <br /> Prepared By �,� cked By <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL (NSPECTIOfV <br /> PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE <br /> RECEIPTED FOR BY A CENT ALEP RMI IDTTING OFFICE OF PASCO COUNTY <br /> Acknowledgement below does not imply acceptance of concurrence, but slmply recelpt of a copy of this form,placing <br /> the building permit owner on notice of this assessment and the conditions of payment for same. <br /> DATE <br /> RECEIVED BY <br />� RECEIPT NO. DATE gY <br /> I <br />