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� <br /> � -, _ <br /> '•, <br /> ''��9� <br /> , ����� ���e� 1 �� ��M���� <br /> �� <br /> Permit No. ��p %�� <br /> Date Permitted //- /�--`� <br /> Builder Name/Owner Name IY�Q���O� ��jy,7�� Control # <br /> � <br /> County Parcel No. Q��I_�f-006v-�b3oa- UG�"t� SubDiv: s��v�r��O <br /> Address/Location � p a� ���� <br /> ti <br /> Classification/Type of Use � i�l I� " I <br /> TRANSPORTATION IMPACT FEE Rate: Sq Ft Unit: Zr J� 9 <br /> Exempt [] Yes � No How Determined <br /> Impact Fee Amount $ ��O J�Z Zone No. T,qZ: <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $ _ �� '��, Z <br /> (057) Mobile Home <br /> (058) Other Residential <br /> 123) Coliection Fee <br /> Exempt Yes �] No How Determined <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit <br /> Recreation Total <br /> Zone TOTAL AMOUNT $ � <br /> 7-� �� � <br /> Exempt � Yes � No How Determined <br /> LIBRARY �EE <br /> Land Account Land Credit <br /> Land Total � <br /> Facility Account Facility Credit <br /> Facility Total <br /> Exempt � Yes � No How Determined �— <br /> Total Amount <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT <br /> Prepared By Checked By <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FIIVAL INSPECTION <br /> PERFORMED UNTIL THE 70TAL AMOUNTS LISTED HAVE <br /> RECEIPTED FOR BY A CENT AL p�RMID TING 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 building permit owner on notfce of this assessment and the conditions of payment for same. <br /> DATE <br /> RECEIVED BY <br /> RECEIPT NO. DATE BY <br />