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� <br /> i <br /> „ �+ �+^ r p <br />� <br /> .? �Aa�. !�� .Ai�.lU���� FL.�R�QA <br /> i� <br />{ 7tJ� <br />� "" Permit No. ���Z�J�J� <br /> Date Permitte <br /> Builder NameJOwner Name �f,1�`Zl�L1`�. 4�'(Si2{CT�t} _ Controi# <br /> C�unty Parcel No. (�3-.�o Z/-()2.z�-()�[�OC7'"�130 SubDiv: c����d�C��(�ftjt4,,(�,, <br /> � � �� 7 �-sh�`lf � " <br /> AddresslLocatlon j '� � <br /> Classificatlon(Type of Use S t���r t t/ <br /> r <br /> TRANSPORTATION tMPACT FEE Rate: Sq Ff Unit: l� 7� <br /> Exempt � Yes [] No How Determined <br /> � lmpact Fee Amount $�,_�����_ Zone No. TAZ: <br /> � <br /> SCHOOL 1MPACT FEE <br /> Account (056} Single-Family Detached House Amount $ _ ��b, � <br /> (05?} Mobile Nome <br /> (658} Other Resldential <br /> 123) Collection Fee <br /> Exempt [� Yes � No How Determined <br /> �, PARKS AND RECREATION FEE <br /> Land Accounf Land Credit Land Total I <br /> I <br /> Recreation Account Recreation Credit Recreation TQta! <br /> �, Zone T(?TAL AMOUNT $ ��p�,�,j� <br /> Exempt (� Yes ❑ No Fiow Determined �> <br /> L.IBRARY FEE <br /> Land Account Land Credit Land Total <br /> Facility Account Facility Credit Facility Total <br /> Exempt � Yes ❑ No How Determirmed ToEal Amount ,.._� <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT <br /> Prepared By Checked By <br /> NO CERTiFiCATE C3F OCCUPANCY WIL.L BE ISSUED OR FINAL INSPECTfQN <br /> PERFORMBQ UNTIL THE TQTAL AMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMITTING OFFlCE OF PASCQ GOUNT( <br /> Acknowledgemenk below does nok lmply acceptance of concutrence,but simply cecelpt of a copy of this form,piacfng <br /> the building permit owner on notice of this assessment and the conditions of payment for same. <br /> QATE RECENED 8Y , <br /> REGElPT NO. DATE BY <br />