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� # '.I <br /> i : ' �.. � ����^�7 l�h�����! ���ed�'�� <br /> :+ � <br /> ' ' � Permit No. � � <br /> Date Permitted / -- r i <br /> �./�- _ �-�� _ � <br /> Builder Name/Owner Name ____� � Contral# <br /> County Parcel No'. �c,�-.�- �.l-(�2��"���'`��� �ubDiv: �Gc7^ t'Ji�'.. <br /> AddressiL�catian� ��7�.�b �ar r��P.- ,�d Se- � �-�� "� <br /> ClassificatianlType of Use 1 11'Gf��2 l�IL''Y�'I� � <br /> 7RANSPORTATI�tJN lMPAGT FEE Rate. Sq Ft Unit: �i ��� <br /> Exem t Y Is �to How Determined <br /> p ❑ ❑ <br /> � impact Fee Amo�nt $ ,�r`�c�(} Zone No. TAZ: <br /> �� <br /> SCHODL tMPA►GT FEE �-�- � <br /> Account {056) Singie-Famiiy Detached House Amount $ <br /> (057) Mobile Home <br /> (058� C7ther Residentiai <br /> ' 123� Colfection Fee <br /> Exempt [� Yes � Na How Determined <br /> j <br /> PARKS AND RECREATI4aR! FEE <br /> Land Account � �Land Credit Land Totai <br /> Recreation Account Rscreation Gredit Recreation Totai <br /> Zone � TOTAL AMOUNT $ 7C��`�� <br /> Exempt ❑ Ye,s [] No How Determined <br /> ,� <br /> LIBRARY FEE I <br /> Land Accaunt Land Credit Land Total <br /> Facility Account I Facifity Credit Faciiity Totai <br /> Exempt 0 Y�s (� No How Determir�ed Tatai Amount � <br /> RESOURGE FEE /�� ERU <br /> TOTAL AMOUNT �' l,P�_1� �(�+ <br /> � ' �� <br /> Prepared By � t � Checked By <br /> ! <br /> NO CERTIFiCATE OF OCCUPANCY'4�lILL�� ISSUED OR FIPJAL lNSPEGT{ON <br /> PERFORMED UNTI�.THE 70TAL AMOUNTS USTED HAVE ' <br /> BEEM PAID AND , <br /> RECEIPTED FOR �Y A CEIdTRAl. P�RMITTING OF�{CE C1F PASCO CtIUIt�iTY � <br /> Acknowledgement�efow does not impiy acceptance of concurrence,but slmply recelpt of a capy of this form,placing <br /> the build'ing perm(t owner an notice of this assessment and th�conditions of payment for same. <br /> I h <br /> I �-- �`2 �l � �Ec�'�Q B�P.��� <br /> � <br /> DATE <br /> ' RECEIPT NO. ' DATE BY �� , <br /> �_-- � <br />