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�� <br /> '•, <br /> _ �. : �A��t� C�UNT'Y, ����IDI� <br /> .,,. . <br /> �� <br /> `. Permit No. ��p ...� ,� <br /> Date Permittsd — <br /> Gt.G-� o <br /> Builder Name/Owner Name l�t �.�i9'H�� ' � C ntrol# <br /> Y ����-�1- od������r��l�a SubDiv: �rr� ��c�I <br /> Count Parce! No. <br /> Address/Location � � ����� �� �-l/� `�� <br /> ClassificationlType aC Use �}��Q'.� �i'�-}�' <br /> TRANSPORTATION IM!'ACT FEE Rate: Sq Ft Unit: <br /> Exempt � Yes ❑ No How Determined <br /> impact Fee Amount $ �t���''� Zone Na. TAZ: <br /> SCHC3�t�IMPACT FEE <br /> Account (056} Single-Family Detached House Amount $ �.%� <br /> (057} Mobiie Home <br /> I (058) Other Residentla! <br /> 123) Caliection Fe� <br /> Exempt [� Yes [] No How Determfned <br /> PARKS AND RECREATI(?N FEE <br /> ' Land Account Land Credit Land Tota1 <br /> Recreatinn Account Recreation Credit Recreatian Totai <br /> Zone T(7TAL AMOUNT $ �6,�-�� <br /> Exempt [] Yes [� No How Determined <br /> LIBRARY �EE <br /> Land Account Land Credit Land Tofa1 <br /> Facility Accaunt Facifity Credit Facility Totai <br /> Exempt [] Yes ❑ No Now Determined Totai Amount�_��7_„_ <br /> RESOURCEF�E ERU <br /> TOTAL AivIC3UNT <br /> Prepared By ' Checked By <br /> NO GERTIFICATE OF t}CCUPANCY WiLL BE iSSUED OR �iR1Ai. iNSPECI'ION <br /> PER�dRMED UNTIL THE TOTAL AMOUNTS LISTED HA1IE <br /> BEEN PAID AND <br /> RECEiPTED FC3R BY A CENTRA�. PERMITTING OFFiCE OF PASCO COUNTY <br /> Acknowtedgement below daes not imply acceptance of concurrenca,but simpiy recelpt af a copy of this form,placing <br /> the building permit owner an notice of this assessment and the conditians of payment for sama. <br /> DATE RECEfVED BY <br /> RECEIPT NO. DATE BY <br />