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i <br /> � � � <br /> ��t <br /> f"'t9� �'i <br /> R ' 'g • <br /> � F :. ;= P�S�C� �C�l�f�`T1(, F��►F�1��► <br /> : � <br /> :. , <br /> i. <br /> . . �I o � <br /> Permit No. �7� <br /> . <br /> Date Permitte���� <br /> Builder Name/Owner Name 1��t'r i+� ���7'� l�''�' Contro)# <br /> County Parcel No, l������ � lD'L��� �� Subdiv: �c������`���''`2-� , <br /> � �L��� J"r �f � 7� <br /> Address/Location Ccr�`•� t��.'S'�- G- �-T` �� <br /> Classificafion/Type of Use �%ir''�cl�'1 /�4`y'►'1'�- <br /> TRANS6'QRTATION IMPACT F�E Rate: sq Ft unit: li ��� � <br /> 1 <br /> Exempt [] Yes ❑ No How Determined <br /> ' impact Fee Amaunt $ �j T�Qr Zone No. TAZ: <br /> � <br /> SCHOOl. IMPACT FEE y �/ . <br /> Accaunt (056� Single-Family Detached House Amount $ ���� ' <br /> (057) Mabile Home <br /> (058} �ther Residential <br /> 123.) Collection Fee <br /> Exempt (� Yes � No How Determined � <br /> � ' <br /> PARKS AND RECREATI�}id FEE <br /> Land Account �� Land Credit Land Totai � <br /> Recreation Accalunt Recreation Credit Recreatian Totai <br /> Zone I TOTAL AMOUNT $ �� �S� <br /> Exempt (� Yes [] No How Determined <br /> LiBRARY F�E � � <br /> Land Account I Land Gredit Land Total <br /> Faciiity Account Facility Gredit Facility Total <br /> Exempt � Y�s [] No How Determined Total Amount �� <br /> i <br /> RESOURCE FEE ( � ERU � <br /> TOTAL AMOUNT � tQ� <br /> � f 1 ��� : <br /> � <br /> Prepared By ; ' � Checked By <br /> I <br /> NO CERTIFlCATE OF OCGUPANCY�lI1�.L �E ISSUED OR �fNAL INSPECTlt3N <br /> �'PER�ORMED UNTIL 7HE TOTAL AMOUNTS LiSTED HANE <br /> BEEM PAID AND <br /> RECElPTED FC1Ff BY A CI�MTRAL �ERMITTING 4FFtCE Gl� PASCO COUNTY <br /> �� <br /> Acknowledgament below dpes not impty acceptance of cancurcence,but simpfy receipt af a copy of this form,placing <br /> the building permit owner on natice of this assassment and fhe.conditions of payment for same. <br /> � 1����1�c� ����� _ <br /> DATE RE� <br /> I ED BY <br /> RECElPT NO. DATE BY _ ��!'�� <br /> � � <br /> , _- <br /> I — , <br />