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� �i <br /> . ,; . <br /> : : i�l�►��� ����`TY, FLQ�IC��► <br />, : . <br /> t� <br /> ' " Permit No. /� 7�d� <br /> , Date Permitted �l� <br /> � Bu lder NamelOwner Name � r� J��ri C�11 Contrn{# <br /> __���.��� " <br /> � Co nty Parcel No. �j-�b- Zj-i9 2.1�?�- D d DC�7�— �v f4 SubDiv: l.(,�G�trtc�t� f�v`P� <br /> I AdI ressiLocation � � � �� �t"�a..�r`i�. �d�'e.. �� �" �v , <br /> C! ssif�catRanCType af Use ��t,�i�.�1(3'Y'�''t'� <br /> TRANSPORTATtQN lMPACT FEE Rate: Sq Ft Unit: �r � 7 �- <br /> Ex�mpt a Yes ❑ No How Determined <br /> � im� act Fee Amount $ �� ��� Zone No. TAZ: <br /> S Hi30L iMPACT FEE <br /> Ac ount (056} Singie-Family Detached House Amount $ �� <br /> (057} Mobile Home <br /> (058) Other Residential <br /> 123) Gallection Fee <br /> Exempt [] Yes ❑ No How Determined <br /> P ,RKS AND RE�REATIQN FEE <br /> La d Account Land Credit Land Tatai <br /> R creation Accounk Recreation Credit Recreation Totai <br /> Zo e T�TAL AMOUNT $ � �S2�. �,? (a <br /> Exempt [� Yes ❑ No How Determined <br /> !.f RARY FEE <br /> La d Accaur►t Land Credit Land Tatal <br /> F ciiity Account Facility Credit Facility Totai <br /> E empt [� Yes ❑ Na How Determined Tota1 Amount ��'�� <br /> R�SOURCE�EE ERU <br /> T �TAL AMOUNT <br /> � <br /> � <br /> Pr pared By ` � Ghecked By <br /> � <br /> i <br /> ; NO CERTIFICATE OF OCCUPANCY 1NILL BE 1SSUED OR FINA�{NSPECTlON <br /> � PERFORMED Ut�Ti�.THE TOT�4L kMOUNTS LISTED HAVE <br /> � BEEN PAID AND <br /> RECEiPTE1D ROR BY A GENTRAL.PERMITTING OFFICE OF' PASCO COUNTY <br /> A Iknowledgemsnk below dpes nak lmply acceptance of concurrence,but simpiy raceipt of a copy of this form,piacing <br /> !he buiiding permit owner on notice of th(s assessment and the�conditlons of payment for same. <br /> � � <br /> � <br /> D TE RECE{VED BY � <br /> R CEIPT N4. DATE BY <br /> ��__,�__ __---- <br /> � - <br />