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. ,� . � , _., P �. ��, <br /> f ..�-(.� � ��., �c�_2�,.. <br /> �. �r� <br /> '? �!�'��71/� V�J1�1'���� ���f��6�1� <br /> '�, <br /> " " Permit No. �� <br /> Date Permitte <br /> Builder Namel�wner Name /C. 1��- ���C,!��.,_. Cor►tro!# <br /> �.� �.� F � <br /> County Parcel Na. /"i3-.?..�2/- t�?,.-�0-�dbc�-D13o SubDiv: c�� �''�.Yt�G(,�{,L.S�r f j�.� <br /> U - <br /> Address/Lacation � Y' � 7 ���'t�,�/� t1� <br /> ClassificationCfype of Use r� �'! [ <br /> TRAhiSPORTATiON IMPACT FEE Rate: Sq Ft Unit: �� 7�____ <br /> Exempt ❑ Yes ❑ No How Determined <br /> � impact Fee Amount $���„�-7�'.�- - Zone No. TAZ: <br /> t SCHOt)L tMPACT FEE : <br /> Account (056) Single-Family Detached House Amount $ �-�z ° ��7b, „�� <br /> (Q5T) Mob91e Hame <br /> (058} Other Residential <br /> 123} Callection Fee <br /> Exempt [�] Yes ❑ No Haw Determined <br /> PARKS AND RECREATtON FEE <br /> Land Account Land Gredit Land Total <br /> Recreation Accaunt Recreation Credit Recreation Tatal <br /> Zone TOTAL AMOUN7 $ �� �,�� <br /> Exempt [� Yes ❑ No Haw Determined <br /> ,, <br /> LIBRARY FEE <br /> Land AcGount Land Credit �and Totai <br /> Facility Account Facility Credi# Facility Tota! <br /> Exempt [] Yes ❑ No Haw Determined Tcatal Amount �-�� <br /> RESOURCE FEE ERU <br /> TOTAL AMQUNT <br /> Prepared By � Checked By <br /> ,. NO CERTIPiCATE OF CICCUPANCY 1NiLL BE ISSUEb 4R FINAL M(�SPECTION <br /> PER�KJRIUIEQ UNTlk.THE YOTAL AMCIUNYS LISTED H6�,VE <br /> BEEN PAtD AND <br /> � RECEiPTED FOR BY A CENTRAI� PERIlAITTING OFFICE OF PASGQ GOUMTY <br /> Acknowtedgement below does noE imply acceptance of concurrence,but slmply recelpt of a copy of this form,plactng <br /> the building permit owner on notice of thls assessment and the condltions af paymenk for same. <br /> QATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />