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i` <br /> i <br /> , �I <br /> � lPAS�C� �0►�!(�TY, FL��t���4 <br /> . � � ,. <br /> I Permfit Na � 7��� <br /> Date Permitted j/--�� <br /> ` BuiEder NamelOwner Name � � ��fY``�,� ��j,,��� Gantrol# <br /> � <br /> '� Gounty Parcei No. Q'�{��—�%�j�7D_I�02pd �SubDiv, �;� r/pa;�,,� <br /> Address/l.ocation `��0�� �y�Q � p�� � ' <br /> Classification/Type of Use �'i `Q �y <br /> , _ <br /> ' TRANSP4RTATION IMPACT FEE Rafe: Sq Ft Unit: _.3�/'�� <br /> Exempt � Yes C] No Ftaw De#ermined ' <br /> Impact Fee Amount $ �, �a3� Zone No. TpZ: <br /> SCHOOL IMPACT FEE <br /> Account (056� Single-Family Detached Houss Amoun# $ f���,f.Z� <br /> {OS7} Mobile Home <br /> (058) Other Resldential ' <br /> 123) CallecE9on Fee <br /> �I Exempt Yes � No How Determfned <br /> PARKS AND RECREATIOtd FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation Total <br /> Zone T�TAL AMOUNT _$ `7�,-�j.`},�j <br /> Exempt � Yes [� No How Determined <br /> L.IBRARY FEE <br /> �and Accounk Land Credit Land Tafal <br /> F'acility Account Facility Credit Facility Total <br /> Exempt � Yas [� No How petermined Total Amount �""'� <br /> --_._...._ <br /> RESOURCE FE� ERU <br /> TOTAL AMOUNT <br /> Prepared By Checked By <br /> NO CERTlFlCATE OF QGCUPANCYlNI�L BE ISSUED OFt FiNA�INSPECTION <br /> PER�ORMED UNTiL THE 70TAL AMOUNTS LISTED HAVE <br /> BEEM PAID AND <br /> ( E2EGEIP7ED Ft?R BY A GENTRAL PERMlTTI[�IG OFFICE OF PASCO COUf+t'Ty <br /> i <br /> � Acknowledgemsnt below does not lmply accaptance of concurrence,6ut sEmply recslpt of a copy ot this form,piacing <br /> the buitding pertnit awner on notica of ihis assessment and thq conditions of payment far same. <br /> DATE RECElVED BY <br /> RECEIPT NO. DATE gY <br /> �.�..__ __ <br />