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� <br /> i � � <br /> . , '- • � <br />' , � � ` .; ��1.�'l.��i� �i��l���y ��� '���� <br /> , <br /> " � Permit No. 7'7`'�p <br /> Date Permitted (� <br /> 8uilder NamelOwner Name !,� Controi# <br /> Caunty Parcei No. �d —�C�(,�"1 C} SubDiv: �`.(�NIC�C� <br /> AddresslLocation �7 ?S��j"/—���"r L, GE/JSrr� �`f � <br /> Classification/Type of Use��.�it 1io37tE" /'��t��tr�i` <br /> TRANSPORTATIQN IMPACT FEE Rate: Sq Ft Unit: ���� <br /> Exetnpi � Yes � No Maw Determined <br /> impact Fee Amount $ c�b3Z•tf� Zone No. TAZ: , <br /> SCHOOL IMPAC7 FEE .-y� , <br /> Account (056) 8ingle-Family Datached Hause Amount $ ( (�l/ <br /> (057) Mobile Home <br /> {058) Other Resldentia! <br /> 123} CoilecEion Fee <br /> Exempt �lYes [� No Haw Determined <br /> PARKS AND RECREATION FEE <br /> Land Accounk Land Credik Land Tota! <br /> , <br /> Recreatian Account Recreation Credit Recreation Total <br /> Zone TtJTAL AMOUNT $ ��i�� <br /> Exempt [� Yes � No How Determined <br /> LIBRARY FEE <br /> Land Account Land Credit Land Totai <br /> Facility Account Facility Credit Faci(ity Tata) <br /> Exempt [� Yes ❑ No How Determined Tatal Amount ----,��� <br /> RESOURCE FEE EI�U <br /> T07AL AMOUNT <br /> Prepared By r Checked By <br /> NO CERTIFICATE OF OCCUPANCY VIIIL.L BE lSSUEQ OR FINAL tNSFEGTlON <br /> PERFORMED UNTlL 7NE TO7AL.AMOUNTS LISTED HAVE <br /> BEEN PAID AND' <br /> RECElPT�D FOR BY A GENTF2AL P�RMlTTlNG tOFFICE OF PASCO CG?UNTY ' <br /> �' <br /> Acknowladgemant below does not fmply acoeptance af corrcurrence,6ut simpiy receipt af a copy of this form,ptacing <br /> the buildNg parmit owner on notfca of thts assessment and th�conditions af payment for sama, <br /> DATE RECEIVED BY <br /> RECElPT RlO. DATE BY <br /> ,� <br /> . i__ ------ _ ----___- / <br /> �--- ��--�- <br />