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` � - �■ _ <br /> { . <br /> �; ,�r� �'� <br /> � � � � �'�►�CC� �COI�NTY, �Lt��lDA <br /> ��: . <br /> . .� <br /> ., ,. ,_ J�z <br /> � Permit No. �� � <br /> - Date Permitted ��� , <br /> I , ` <br /> Builder Name/Owner Name �.�_ ��rC(� ' �--G��2-�/`��G(' - t'�rYy Contro! # <br /> � <br /> County Parcel No. �"�Z.5-� OI/G�--�CiC)�C�-���/`� SubDiv: �i . �?���� <br /> � <br /> ; � <br /> ddress/Location ���� �j�.l� /'�Jll/ <br /> � , <br /> Glassification/Type of Use �7���rtC�..L, -- �,�`� �p,•;��,�� <br /> T;�ANSPO�tTATION IMPi4GT FE� Rate: S � � <br /> q Ft Unit: � � ..� <br /> EXempt [] Yes [] No How Determined <br /> i <br /> � I�pact Fee Amount $ Z,.G�� �,�� �i� Zone No. TAZ; <br /> S'CHOOL IMPACT FEE <br /> A�ccount (056} Single-Family De#ached House Amount $ --��� <br /> � (057} Mobile Home <br /> (Q58) Other Residential <br /> 123) Callection Fee <br /> E empt �] Yes [� No How Determined <br /> � <br /> P'ARKS AND RECREATION FEE <br /> Land Account Land Credit L.and Total <br /> R�creatian Accaunt Recreatian Credit Recreation Total <br /> Z I�1e TOTAI. AMOUNT $ '`�� <br /> E1xempt C] Yes � Na How Determined <br /> 'I <br /> �.1+BRARY FEE <br /> Land Account Land Credit Land Tatal <br /> F�cility Account Facility Credit FaGilit Total <br /> �` y ' <br /> Exempt [] Yes � No How Qetermined Tatal Amount `�"" <br /> � <br /> RESOURCEFEE ERU <br /> TOTA�AMOUNT <br /> �� <br /> i <br /> Pi4epared By %� Checked By <br /> � � <br /> � <br /> � NO CIERTI�ICATE C1F OCCUPANCY�VIE�C. BE i�SUED OR �tNA�. INSPECTION <br /> ' PERFORMED UNTIL THE TOT,4L. AMOUNTS LISTED HAVE <br /> i BEEN PAID ANC} <br /> i RECEIPT�D FOR BY A CENTRAL P�RMITTIIVG OFFICE OF PASCO COUNTY <br /> Acknowledgement below does not imply acceptanca of concurrence,but slmply recelpt of a copy of this farm,piactng � �- . <br /> � the building permit owner on notice of this assessment and the condi#ions of payment for sarna. <br /> � - <br /> ! <br /> � DATE RECEIVED BY <br /> , - <br /> R�CElPT NQ. DATE BY <br /> i <br /> I <br />