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� ' <br /> �I i <br /> � <br />,� ^ c i � <br /> �,, �.. . <br /> r ���. <br /> ' 3 <br /> = P'A�C� ���l�i�T'Y, FL,�C�r�a4 �� <br /> ���.. :: �, <br /> � .. . � �. <br /> Permit No. � � � � <br /> � Date Permitted f c�r�/—j� ; <br /> I '� <br /> Builder fJamelQwner Name �i��.L �-�.�' Gontroi# ; <br /> { <br /> County Parce! No. ,'���`-2�p lc�p--d�d�0�-�Z1 D SubDiv: �2r�pP n�2Q�.,s i <br /> �l � <br /> i ddresslLocation ,�'�'b '�7 �'1_�_�t .c�r,J��S .?� ��� �,I � <br /> �lassificationffype af Use �/fca,fic(�C,�i,�vkE? ���Z�r2.� t � <br /> If � � <br /> �RAIVSPCIRTATI4N IMPACT FEE Rate: Sq �t Unit: � �p � � <br /> `i <br /> �xempt [] Yes [] No How Determined � <br /> �� ���� <br /> � I��mpact Fee Amount $ Zane Na. TAZ: <br /> 1 � <br /> $CHOd! IMPACT EEE - ��,� � <br /> Accaunt (056} Single-Family Detached House Amount $ , <br /> (057) Mobile Home � ' � <br /> {058} Other Residentiai ' <br /> 123� Collection �ee ' <br /> Exempt [� Yes ❑ No How Determined 'j <br /> �y <br /> PARKS AND RECREATION FEE �; <br /> �and Account Land Credit Land Total i <br /> 1� I <br /> Recreatian Account Recreation Credit Recreation Total ; <br /> �one TOTAL AMOUNT $ �..3. �7� � <br /> � � <br /> i <br /> Exempt [] Yes ❑ No Haw Determined <br /> � <br /> LI�RARY FE� <br /> Land Account Land Credit Land Total <br /> Facility Account Facility Credit Facility Total '� <br /> 1 xem t Yes No How Determined T�tat Amount �"'�� � <br /> � P ❑ ❑ <br /> RESCIURC� FE� ERU ' <br /> �"OTAL AMOUNT <br /> � � <br /> � <br /> Prepared By ° � � Checked �y <br /> I , <br /> � Nt3 CERTtFiCATE OF OCCUPANCY WILL BE ISSUE� OR.EINAL INSPEGI'IQN , <br /> I PER�dRMED UNTI�7HE TOTJ�� AMtJUNTS USTlED HAVE ; <br /> BEEN PAtD AND � <br /> RECEiPTED FOR�Y A CENTRAL PERlU!!Tl'!NG �FFlCE O� PASGO COUNTY • <br /> - - � - � - '. � <br /> � Acknowiedgement below does not Impiy acceptance of concurrence,but simply rscelpt of a copy of this form,p{actng � <br /> the building permit owner on notica of this assessrnent and the conditions of payment for same, i <br /> I i <br /> � <br /> t <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br /> � , <br /> .I .. . .. <br /> - �� <br /> i <br />