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. - ' .� <br /> ? ����5� ������a F������ <br /> ,' <br /> .� . Permit tvo. I 7Df Z <br /> pate Permitted 2-/?-/� <br /> Builder Name/0wner Name 1�-/L' lQ�G�r 1�'"a+'�'�•'.�_ Control# <br /> __� Q <br /> Gounty Parcel No. j)`r�-2.�. Zf-130�a�-�f)��-(���j SubDiv: �r�tlPr22�D <br /> AddresslLocatlon ��t z-$ ,�"�i�(�� �C[t`5G � � <br /> Classification/Type of Use ,,��� �,� �� <br /> _�T <br /> TRANSPORTATION 1MPACT FEE Rate: Sq Ft Unit: 2-/"7 y <br /> Exempt [� Yss [� No Haw Defermined <br /> Impact Fee Amount $ 3�v.�Z • �a Zone No. TAZ: <br /> SCHOOL IMPACT FEE <br /> Account (d56) SingEe-Famiiy Detached Hause Amount $ _ ����• Z-� <br /> (057} Mobi(e Home <br />� (058) Other Residential <br /> E 123} Caltection Fee <br />� Exempt [� Yes [� No How Determined <br /> PARKS ANd RECREATIOFI FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreakion Credit Recreation Total <br /> Zone TUTA�.AMOUNT $ � r p_��_ <br /> Exempt � Yes �] Na tiow Determined <br /> I.IBRARY FEE <br /> Land Account Land Credit �and Total <br /> Facility Account FaciUty Credit Facility Tota! <br /> Exempt � Yes � No How Determined Total Amount G� <br /> RESOURCE FEE ERU <br /> TOTALAMOUNT <br /> i <br /> Prepared By � Checkeci By <br /> ' NO CERTIFICATE OF OCCUPANCY WILl.BE iSSUED OR FINA�INSPECTION <br /> PERFORMED UNTIL THE 70TAL AMQUNTS L.ISTED HAVE <br /> BEEN PAID AND <br /> , F2ECEIPTED FOR BY A GENTEiAI.PERtV11TTENG C}FFIC�4F PASCCf COUNTY <br /> �� Acknowledgement betaw does nof{mply accepfance of concurrence,but slmply recelpt of a capy of this form,placing <br /> the building psrm(t owner on notfoe of this assessment and the conditfons of payment for same. <br /> QATE REGEIVED BY <br /> RECEIPT NO. DATE BY <br />