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� , i <br /> , � <br /> �� , <br /> / � ° ��. <br /> , �; : _ �/��'ii�►� �:�����, ��,..���C1/� <br /> ,, <br /> . � ,� <br /> � " ' Permit No. � ��3 2. <br /> � Date Permitted �-� <br /> I `J`� �� <br /> �� Builder NamelOwner Name _,� � ttOr 1�`-�-�1� Controt# <br /> i <br /> ' County Parcel No. ���Z(o-Z.j-(7�1��--�ZFX}' �r� SubDiv: �'� l����a_ <br /> I <br /> � AddresslLocation ,��o(�?2 ��"+r`t 1� �'. �� <br /> I ' f <br /> � ClassifcationlType of Use �t � �� � L� <br /> � TRANSPORTATIOi�IMPACT FEE Rate: Sq Ft Unit: `� ,c:31�J Z <br /> Exempt ❑ Yes [� No Now Determinad <br /> � impact Fee Rmaunt $ �, � 3� Zone Na. TAZ: <br /> I <br /> 4 SCNOOL IMPACT FEE ,Z� <br /> i Account (056} Single-Family Detached House Amount $ �T Q7�. <br /> {057} Mobile Home <br /> (058) Other Resfdentfal <br /> 923} Gallection Fee <br /> Exempt [�Yes [] Na Now Determ(ned <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Accaunt Recreation Credit Recreation Total <br /> 1 Zone TOTAL AMOUNT $ ��u � s�, <br /> � Exempt �Yes � Na How Determined <br /> � LIBRARY FEE <br /> � Land Account Land Credit Land Tatai <br /> Facility Account Facil[ty Credit Facility l`ota! <br /> Exempt [] Yss ❑.No How Determined To#al Amotent "z.i <br /> RE30URCE FEE ERU <br /> Tt�TAL AMOUNT <br /> Prepared By Checked By <br /> NC}CERTtF{CATE OF OCCUFANCY WtLL BE ISSUED OFt FlNAL{NSPEC7iON <br /> PERFC)RMED UNTiF,TNE TOTA[.AMOUNfiS LISTED NAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMlTTINC3 l?FFICE OF PASCO COtJNTY <br /> Acknowiedgement below does not Imp{y aaceptance of concurranca,b�t stmpiy receipt of a copy of this form,placing <br /> the bu{Iding parmit owner an notics ot ihis assessment and th�condlkions of payment for sama. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br /> . � <br /> � <br /> � <br /> � -- - __.—- <br /> � <br />