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• +�1 <br /> �� <br /> •1• ` �p <br /> � > �� �= 1��� ����� { i ����'�� <br /> � <br /> � <br /> f • / <br /> . ,., Permit No. t � 7 � <br /> Date Permitted r 7�/ <br /> C�_� <br /> Builder NamelQwner Name I� +C' ��G�'�I Cantroi# <br /> County Parce! No. �.�-�(o—.�..�--('jZ.�Q-CjQ�_(� SubDiv: 11�14�-�nt,�+ ,���^�� <br /> �__i���5 <br /> AddresslLocation �"7 �j �o l�`rt�.i r�i�2.... btC).Te.. !�Y-� �T �5�� <br /> CiassificationlType of Use c,�r`n��2 �t�nr�c� <br /> TRANSPOi2TA1'14N IMPACT FEE Rate: Sq Ft Unit: <br /> Exempt � Yes [] No Haw Determined <br /> � Impact Fee Amaunt $ u�c��- z Zone No. TAZ: <br /> SCHO�L IMPACT' FEE <br /> Account (a56} Singie-Family Detached House Amount $ ._,�-�' <br /> (05?} Mobile Home <br /> (058) Other Residential <br /> 123) Collection Fee <br /> Exempt Yes [� No How Determined <br /> PARKS AND RECREATtON FEE <br /> Land Account Land Gredit Land Tata) <br /> ' Recreation Account Recreation Credit Recreation Totai <br /> I <br /> � Zane Tt�TAl.AMQUNT $ "f�' ��� <br /> Exempt [a Yes [] No Haw Determined <br /> � <br /> LiBRARY FEE <br /> Land Account Land Credit Land Tatal <br /> IFacility Account Fac�lity Credit Facility Tata{ <br /> Exempt [� Yes [] Na How Determined Total Amount �_���_. <br /> RESOURCE �EE ERU <br /> TOTAl.AMQUNT <br /> Prepared By � Checked By <br /> NO CERTlFIGATE C?F OCCUPP►NGY V11!!.L BE ISSUED C1R FINAL tNSPECTION <br /> PERFt)RMED UNTiL THE Tt)T�4.L A►iVIOUNTS LISTED HAVE <br /> BEEN PAID �ND <br /> RECEIPTED FQR BY A CENTRA►L PERMlTTiNG OFFICE O� PASCO COUN'i'Y <br /> Acknowledgement below closs nat!mply acceptance of concurrence,but simply receipt of a copy of this form,placl�g ' <br /> the building permit owner on notice of this assessment and the conditians of payment far same. <br /> DATE RECE{VED BY <br /> RECEiPT N0. DATE BY <br />