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- — <br /> , <br /> , � i�Y1►►e7�i� �e��d���q ���JI'�l6J� i' <br /> i <br /> " ' Petmit No, ! ��lJ"�� <br /> Date Permitted . - �_ <br /> Bui{der NametOwner Name � � �"�� L�G Control# <br /> County Parcel No, ��-Z�-Z�-DD�f1�G�DIQa�-aJ�a SubDiv; c5! i/U��a <br /> Address(Location �y�p j��y �t,i�r`P�2 J't�2. C� <br /> Ciassificafion(type of Use v`^r�''���� yzLm�l� l�'e-� ' <br /> TRANSPORTATION iMPACT FEE Rate: Sq Ft Unit: �'/��� <br /> , <br /> Exempt [� Yes [] No Haw Determined <br /> tmpact Fee Amount $ 3�3Z' Zane No. TAZ: <br /> SCHOOL IMPAC7 FEE <br /> Account (056) Singls-Famity Detached House Rmount $ �f �]�� Z�a <br /> (057} Mobife Home <br /> (058) Other Residential <br /> 123) ColEection Fee <br /> Exempt [S] Yes (� No How Determined <br /> PARKS Al�Q RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credik Recreation Total <br /> Zone T07AL AMQUNT $ ����v�� <br /> Exempt �]Yes (� Na Haw Datermined <br /> LIBRARY FEE <br /> Land Accaunt Land Credit Land Tatal <br /> Facifity Accaunt Facility Credit Faciliry Totai <br /> Exempt � Yes � No Haw Defermined Total Atnount � <br /> RESQURGE FEE EF2U <br /> TOTAL AMOUNT <br /> Prepared By ' Checked By <br /> NC?CERTIFiCATE OP dCCUPANCY WILL BE ISSUED OR FINAI.INSPECTION <br /> PERFO}2MED UNTIL THE TOTAL AMOUNTS LlSTED HAVE <br /> BEEN PAID AND <br /> RECEtPTED FOFt BY A CE4dTRAL PERMITTING OFFiCE O�PASCO COUNTY <br /> Acknowledgemenk below does not!mp{y acceptance of concurrencs,but simpiy recalpt of a wpy of khis form,placing <br /> the bufiding perrnit owner on notice of this assessmenk and ttta conditions af payment for same. <br /> DATE RECENED SY <br /> RECElP7 NO. DATE 8Y <br /> � . . .. <br /> ' ,.�.�.��,.�..-._�,��.��..-m._... ._.________- ____ <br /> �..� _.�._�_�:_:.�._���. a _ d <br />