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i <br /> ! ; 1 ��;. ', ���7d� 'lte�S�P 4'�►� !S B � ��SaA�i�� <br /> t� <br /> " " Permit Na. / ��� � <br /> Date Permitted�7�� <br /> Bu'Ider Name/Owner Name ���{( (,���L��� Cantrol# <br /> Ca nty Parce! No. 1�J- �.�- {�7,�fd--� �(�(�ubDiv: �����'� <br /> Ad resslLocation ���1�������'�- /�--�� �� ���� <br /> C! ssificationCType of Use �GG�'I''i����'- <br /> � <br /> I TR NSPQRTATlON 1MPAGT FEE Rate: Sq Ft Unit: /i�`7� <br /> �, Ex mpt ❑ Yes ❑ No How Determined <br /> � ' tm�act Fee Amount $ �r �1�0 � Zone Na. TAZ: <br /> SG C30L IMPACT FEIE <br /> Ac�ount (056) Single-Family Detached Hause Amount $ r�'.�� <br /> `� (057� Mobile Home <br /> (058} Other Residential <br /> 123) Coilection Fee <br /> Ex mpt [] Yes ❑ Na Haw Determined <br /> PA�tKS AND RECREATICIN FEE <br /> Lat�d Accourtt Land Credit Land Total <br /> Re reation Accounk Recreation Credik Recreation Total <br /> Zo e TQTAL AMOUNT $ `7 �f�'-�� <br /> Ex mpt [] Yes ❑ No How Qetermined <br /> LI RARY FEE <br /> La d Account Land Credit Land Total <br /> Fa�ility Account Facility Credit �acility Tota! <br /> Ex mpt ❑ Yes [] Na How Determined Total Amount � <br /> RE'�SOURCE FEE ERU <br /> TO�TAL AMOUNT <br /> � <br /> Pr I pared By � Checked By <br /> Rlt� CERTIFiCATE OF OCCUPANCY!lVt�L BE ISSUED QR FINAL tNSPECTIUN <br /> PERFORMED t1NT1�.THE 70TAL ANIOUNTS LlSTED HAV� <br /> ' BEERI PAID AND <br /> REGEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY <br /> Acl<nowledgement beiow daes nat impiy acceptance of concurrence,but slmply racelpt of a copy of this form,placing <br /> the bullding permik owner on natice of thls assessment and thQ conditions of paymant for same. <br /> �I <br /> I D E RECEIVED BY <br /> i � <br /> � R CEiPT N4. DATE BY <br />