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�'� i <br /> _— '� i <br /> i _" . i <br /> • � <br /> { <br /> (� ,. ' <br /> ./ <br /> ! ,�� � <br /> ! » '`. , ; ',. ; ���1C!� 1e0�M37�� ■ e ' f1 !$As��6 C."�0�Y 1d <br /> •�1 1' � <br /> „ �. , Permit No. ( ����- <br /> Date Permitted � ��•/' <br /> Builder Name/(?wner Name ��� ��Y��7't C�� Contral# � <br /> �/ ' �jI I <br /> C �unty Parcel No. �"T`�—�-�,�1���^L7L�f�,��� SubDiv: � `V�Y�GI?� i � <br /> A dresslLacation �� �c� (_..'G'�-�V7� 1 n� �'� . <br /> � j� ���� <br /> CI' ssification/Type of Use �i <br /> TRANSPURTATION IfVIPAC`T FEE Rate: Sq Ft Unit: �/ -3�� <br /> E empt ❑ Yes ❑ No How D ermined ' <br /> � Im act Fee Amount $� �(p � Zone No. � TAZ: <br /> � � <br /> � H04L IMPACT FEE ' <br /> Account {056) Single-Family Detached HaUse Rmaunt $ ,� �t �� _ . <br /> {057) Mobile Hame <br /> (d58} Other Residentia! <br /> 123) Coitection Fee � � <br /> Exempt �] Yes �} No How Determined �, <br /> � <br /> P�RKS ANC1 RECREATION F�E <br /> La d Account Land Credit Land Tota! <br /> � ; <br /> ReCreation Accaunt Recreatian Credit Recreation Totat <br /> i ; <br /> Z�` e TaTAL AM�UNT $ 7��'' <br /> � . ; <br /> Ex i mpt ❑ Yes [] Na How Determined <br /> , <br /> Lt Re�\RY�'EE G <br /> La�d Account �and Credit L.and Totai , <br /> , <br /> Fa�cifity Account Facility Credit Facility Total � <br /> --"_`'.�. <br /> Ex I mpt ❑ Yes ❑ Na ow Determin�d Totat Amou � <br /> RE�SOURCE FEE i �7�- ERU <br /> TOjTAL AMOUNT • � � <br /> � <br /> Prepared By Checked By , <br /> ;-�- <br /> � NQ CERTIFlGATE QF 4CCUPANCY WIlL �� (SSUIEb t3R FiNAL fNSPEGTION ' <br /> ' PER�Q►R1VlED UNTlL THE 7UTl�1L AM�'?UNTS LISTEd HAVE � <br /> BEEN PA1D AND ' <br /> RECE{PTED FC3R BY A CENTRAL PGRMITTiNG OFFtCE QF PA�CO COUNTY � <br /> AcE nowledgement below does not imply acasptance of coneurrence,but sli�nply recelpt of a copy of this farm,piacing <br /> , the building permit owner on natice bf this assessment and fhe conditions of payment for same. <br /> � � <br /> � . <br /> � pq� E � RECEIVED BY ' <br /> I B . <br /> RECEIPT NO. DATE Y <br /> .`�.._--- <br />