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i <br /> ' �i <br /> .� <br /> . . ' ����� �I�����y ��.����/� <br /> , <br /> �' <br /> Permit No. �'�'-' <br /> ' Date Permitted //B_ <br /> �R ti� �- <br /> Builder Name/Owner Name 1 Control# <br /> I <br /> ' County Parcel No. 6��Z�- d�'jp_.�Q/(J��QQ�d SubDiv: S'! {�'����/ <br /> I Address/Location 2. v� l(��a �t� j <br /> � BG�J <br /> I Classification/Type of Use CS%1?q'� l� <br /> TRANSPORTATION IMPACT FEE Rate: <br /> Sq Ft Unit: .� Z� 3� <br /> Exempt � Yes � No How Determined <br /> Impact Fee Amount $ ,3� ,3L Zone No. <br /> __ TAZ: <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $ _ !,(, <br /> (057) Mobile Home �76. Zg <br /> (058) Other Residential <br /> 123) Collectlon Fee <br /> Exempt Yes [� No How Determined <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account __ Recreation Credit <br /> Recreation Total <br /> Zone TOTAL AMOUNT $ 7 �� `j'� <br /> Exempt � Yes � No How Determined <br /> LIBRARY FEE <br /> Land Account Land Credit <br /> Land Total <br /> Facility Account __ Facility Credit <br /> Facility Total <br /> Exempt � Yes � No How Determined <br /> __ Total Amount � <br /> RESOURCE FEE <br /> TOTALAMOUNT ERU <br /> Prepared By � Checked By <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE <br /> RECEIPTED FOR BY A CENT ALEP RMI'TT NG OFFICE OF PASCO COUNTY <br /> Acknowladgement below does not Imply acceptance of concurrence,but simply recelpt of a copy of this form,placing <br /> the building permlt owner on notice of thls assessment and th�condillons of payment for same. <br /> DATE <br /> RECEIVED BY <br /> RECEIPT NO. �_ DATE __ gY <br /> I �_ = • ......� _._ ._ <br />