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� _ '�. <br /> .. ;.;y�,� <br />', •;. ,� ����� ���JI���y ������� <br /> i �' � <br /> . <br /> 'y � t ( Permit No, 1 � � �jp <br /> �i�-!h��y�t.rrt�pr- ��S���ate Permitted <br /> Buiider Name/0wner Name P� � �2 Contral# <br /> Gounty Parcel �lo. ��'—���-U1 $O- 0�(�� - 3�1 C� SubDiv: �r� �1+� <br /> AddresslLocation , � �t� 2. �'.,�1-t� i'�(�.�` t E,. �tv� t,,p -�- 3�`� ' <br /> ClassificationlType of Use �10 �j� I�? t�.d�''�- <br /> 1'RANSPC}RTATIt,�N IMPACT FEE Rate: �q Ft Unit: <br /> ExempE [� Yes ❑ Na Haw Qetermined <br /> impact Fee Amount $ 3���� �� Zone Na. TAZ: <br /> , SC�lOOL fMPAGT FEE <br /> I Account (056) Single-Family Detached House Amount $ ,,,� � <br /> (057) Mobile Home <br /> 'I (058) Other Residential <br /> �23) Collection Fee <br /> �� Exempt [� Yes [� No How Determined <br /> ' PARKS AND RECREATION FEE <br /> ', Land Account Land Credit Land Tota! , <br /> Recreation Account Recreatian Credit Recreatian Tota! � <br /> �i Zone TOTAL AMOUNT $ �7�, 3 <br /> ` Exempt � Yes [� No Haw Defermined <br /> �IBRARY�EE <br /> �.and Accaunt Land Credit Land Tatal <br /> , <br /> Facility Account Facility Credit Facility Tota1 <br /> i Exempt � Yes [] No How Determined Total Amaunt �_�� <br /> ; RESQURCE FEE ERU <br /> ! TOTAL AMQUNT <br /> � Prepared By • ��J J � Checked By � <br /> ' <br /> � NQ CERTlElCATE OF OCCUPANCY WILL BE iSSUEb OR FfNAL lNSPECTION <br /> � PERFORMED UNTIL 7HE 70TAL.AMt?UNTS �iSTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE 4F PASGO GOUNTY <br /> Acknowledgement belaw does noE impiy acceptance of concurrence,but simply recelpt of a copy of this form,placing <br /> the building permit owner on notice of this assessment and the conditions of payment for same. <br /> DATE RECEIVED BY <br /> RECEiPT NO. DATE BY <br />