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, , r' � I <br /> •'� <br /> ; ; .. � ���4�'� b9�°����g ������8`"!a <br /> . � <br /> ��, � <br /> '" � Permit Na 1 7�� � � <br /> , <br /> Date Permitted ' <br /> , Builder Name/Owner Name ��� � ��L� � l Contrai# �, <br /> County Parcel No. ��2Yf-�f D l�-��� � SubDiv: ��1�� ���'�'-.� <br /> AddresslLocation � �L�l� J`7'���'`��° r�"sQ- �" �"I���P`� <br /> ClassificationCl'ype of Us� ��%�i'�� /�l��°- <br /> I � <br /> TRAN�PORTATl4N tMPACT FEE Rate: Sq Ft Unit: �1 ��� � <br /> Exempt [] Ye�s [� No How Determined ; <br /> � impact Fee Amo�nt $ �� 7�D� Zone No. TAZ: <br /> � <br /> SCH�OL IMPACT FEE �� <br /> Account (056� Single-�amily Detachad Nouse Amount $ , <br /> � (057} Mobiie Nome ' <br /> (058j Uther Residentiai ' <br /> � 123) Coilection Fee , <br /> Exempt [] Yes ❑ No How Determined <br /> 1� <br /> PARKS AND RECREATICbN FEE � <br /> Land Accaunt � Land Credit Land Total <br /> Recreatian Acca i nt Recreation Credit Recreation Total � <br /> �I <br /> Zane T�TAl. AMt?UNT $ ��i� �..3`�� ' <br /> , Exempt ❑ Ye�s ❑ No How Determined <br /> � I <br /> ' LiBRARY FEE <br /> �, Land Account (, �and Credit Land Tota! <br /> �� <br /> Facility Account Facility Credit Facility Total <br /> � Exempt �] Yek!s �] No How Determined Total Amount �°°-� <br /> I <br /> RESQURGE FEE ERU <br /> TOTAL AMOUN i <br /> , � <br /> Prepared By � ' ���" Checked By <br /> I T---- , <br /> I� <br /> R10 CERTiFiCATIE OF OCCUPANCY V4�t�.L�E ISSUED OR EIhIAL tNSPECTION <br /> PER�OR6�lii�D UNTtl.THE TOTAL AMOUPd7S LlSTED HAVE <br /> �EEN PAID AND <br /> RECEIPTIED FOR BY A CENTRAL. PERMIT'TlNG t�FFiC�OF PA5C0 COUNTY , <br /> Acknowledgement below does not impiy acceptance of cancurrence,but slmply recslpt of a copy o{thls form,placfng <br /> the buildilg permit owner on natice of this assessment and th�conditions of payment for same. <br /> I � <br /> � . ' <br /> DATE RECEiVED BY <br /> RECEIPT NO. DATE BY <br /> � _ -- _ . _.— <br />