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�. � <br /> � , <br /> � :. �� �A�dV� ���1� 1 1 y ������� <br /> t <br /> Permit No. l� � <br /> , <br /> Date Permitted <br /> Builder Name/Owner Name /� Gh Control# <br /> v D2-Z6-2/�d�1�D��b-�3 � � <br /> Count Parcel No, � SubDiv: � r� <br /> Address/Location 7 (bj ���l�l�� U� LO��Cg <br /> Classification/Type of Use /�e�� � I'E� <br /> TRANSPORTATION IMPACT FEE Rate: Sq Ft Unit: <br />', Exempt � Yes � No How Determined <br /> � Impact Fee Amount $u��Z� �� 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 [] No How Determined <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation Total <br /> -� <br /> Zone TOTAL AMOUNT _$ ��fC• �S� <br /> Ex ' � <br /> em t Yes <br /> p ❑ ❑ No How Determined <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 Checked By <br /> NO CERTIFICATE OF OCCUPANCY WILL �E ISSUE� OR FINAL INSpECTION <br /> PERFORMED UNTi�THE 70TAL AMOUNTS LISTED HAVE <br /> BEEN PAID �►ND <br /> RECEIPTED FOR BY A CENTRAL PERMITTI(dG OFFICE OF PASCO COUNTY <br /> Acknowledgement below does not imply acceptance of concurrence, but simply recelpt of a copy of this form,placing <br /> the bullding permit owner on notice of this assessment and the conditions of payment for same. <br /> DATE RECEIVED BY <br />� RECEIPT NO. DATE <br /> BY <br />