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� �t <br /> P'A�i�C} �Q11t�1'1(, FL�R1�A <br /> . <br /> � . <br /> . .,., �. �C <br /> Permit No. <br /> Date Permitted 1l/ `' `� <br /> , J� <br /> ` Builder Name/Owner Name � �£'�t. l..l3Y1.�t � ��✓t Controt# <br /> i / r� <br /> � County Parcel No. ��-2�-Zj-� Z��--(�dC��-�}�3b SubDiv: �Qt��t,� t�I��J'v�-- <br /> AddresslLocation � 7�� 2 !'rCc��'���- ►w�.- �� �� ��`�� ' <br /> � <br /> � ` t �� <br /> ClassificatlonlType of Use cS r�1 �� C , <br /> 'i TRANSPORI'R,'Tt4N iMPACT FEE Rate: Sq Ft Unit: <br /> Exempt [] Yss ❑ Na How Determined <br /> ' Impact Fee Amount $ �b��� Zane No. TAZ: <br /> ' SCH�OL IMPACT FEE <br /> Account (056) Single-Family Qetached House Amount $ �.��' <br /> (057) Mobile Horne <br /> {058) Other Residential <br /> I 123) Coltection Fee <br /> Exempt [� Yes � No How Determined <br /> PARKS AND REGREATION FEE <br /> �' Land Account Land Credit Land Tota! <br /> � Recreatian Rccount Recreation Credi� Recreation Tota! <br /> � Zane TOTAL AMOUNT $ �(g `�•�J�6 <br /> Exempt ❑ Yes � Na Haw Deterrnined <br /> LIBRARY FEE <br /> Land Account Land Credit Land Totai <br /> Facility Account Facility Credit Facility Tatai ', <br /> Exempt ❑ Yes ❑ No How Determined T'otal Amount _��,� <br /> RESOURCE FEE ERU <br /> TOTAL AM4UNT � <br /> � <br /> Prepared By � Checked By <br /> a <br /> � <br /> Nt� CERTiFICATE OF OCCUPAN�Y WtLI.BE lSSUED C1R FtNA�lNSPEC'TIDN <br /> PERFORMED UNTIL THE TOTAL AMClUNTS LlSTED HAVE <br /> BEEN PAID AND <br /> RECEtPTED FOR BY A CENTRAL PERMITTING OFFICE OF t'ASCO COUN'I'Y <br /> Acknowledgernent below daes nat lmply aceeptance af cancurrance,but simpfy receipt af a capy of thts form,piacing I <br /> the building permit owner on notice of this assessment and the conditians of payment far same. <br /> DATE RECEiVED BY <br /> RECElPT NO. DATE BY <br />