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i <br /> � �'r t <br /> ; : � � .:. ;, i�A��� ���N`fY, FL��ID� <br /> :, ; . 1 <br /> , - � <br /> " " Permit�lo, 1��� � <br /> Date Permitted + / 1- .- ! <br /> Builder Name/Ow i e�-fUame y�-!e-y�� t�7"�'��=Y-�/� _ Cantroi# , <br /> ____ J �,�f _f <br /> o t Parcel No� f 2� -���''��2`� 5ubDiv: �G't.7"� r'�'Il�.. <br /> C un y c�.�-- �..�� G� <br /> AddresslLocation ��?'��, r Y zC�.- ✓C4 St' ,� ��� �'� <br /> ClassificationlType of Use' ! Q�G�? l�ld}�1� <br /> TRANSPORTATIDN IMP�CT FEE Rate: Sq Ft Unit: �i ���r ' <br /> Exempt [] Yes [] No How Determined <br /> ` lmpact Fee Amourtt $�c�10 Zone No. TAZ: <br /> SCHOOL IMPACT FEE <br /> Account (056} Singie-Family Detached Hause Amount $ �� <br /> (057) Mobile Hame <br /> (058} Other�Resfdentiai <br /> ' 123}� Collection Fee <br /> Exempt (� Yes [] No How Determ(ned <br /> (� <br /> PARKS AND REGREATtt7N FEE <br /> Land Account {'� Land Credit Land Tata! <br /> Recreation Acco Int Recreation Credit Recreation Tota! <br /> Zone I T4TAL AMOUNT $ 7G� 'f�`<-5�,� <br /> Exempt [� Yel � No How Determined � <br /> LlBRARY �EE <br /> Land Account Land Credit Land Total , <br /> Facility Account , Faciiity Credif Facility Total <br /> Exempt [] Yes [� Na Haw Determined Total AmounE � <br /> (. <br /> RESOURGE F�E; ERU <br /> TOTAL AMOUNTi <br /> I <br /> Prepared By ; � ____ � Checked By <br /> 1 <br /> NO CERTI�tCATE'OF OCGUPANCY M11LL BE 1SSUED (JR FINAL INSPECTIQN , <br /> RERFt3R61JIED UN'�Ik.THE 70TAL AMOUNTS �I51"ED HA1/E <br /> � BEEN PAID AND <br /> RECElPTELI FOR BY A CENTRAC. PEFtM1TTiNG OFFICE OF P�4SCC1 COUNlTY � <br /> Acknowledgertaent befow daes nnt impiy acceptance of concurrence,but slmpiy recelpt of a copy of this form,p{acCng <br /> the building permit owner on notice of this assessment and the,conditians of payment for same. <br /> DATE RECEIV�D BY � <br /> RECEIPT NO. DATE BY <br /> �, _ - <br />