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J ' . <br /> - , " . � �= PA�C4 �t,tUNTI(, FLO►RIDA <br /> , <br /> � Permit Na. ����� <br /> Date Permitted - !� <br /> Builder Name/Owner Name 4�� ��tlY`� C� Control# <br /> CountyparcelNo. 0�?�a Z�-0070�-00]QQ-OfZt7 SubDiv: c�+ ,U�+`�0 <br /> Address/Location 3 �����'iu s� <br /> Classification/Type of Use �I�1 /Q +q� �Ti�''i� <br /> TRANSPORTATION IMPACT FEE Rate: Sq Ft Unit: ����'a- <br /> Exempt �Yes [l No How Defermined <br /> Impact Fee Amaunt � 3 63z'� Zane No. TAZ: <br /> SCHOOL IMPACT FEE t_ <br /> Account (056) Single-Family Detached Hause Amount $ �, �'�(�.Z.,Za <br /> (057) Mobile Hame <br /> . (058} dther Resldentia! <br /> 123j Coifecfion Fee <br /> Exerript [�] Yes [� No How Determined <br /> PARKS AND RECREATtON FE� <br /> �and Accaunt Land Credit L.and Total <br /> Recreation Accounk Recreatian Credit Recreation Totaf <br /> Zane TOTAL AMOUNT $ ��!� J�,� <br /> Exempt � Yes ❑ No Haw Determined <br /> �IBRARY FEE <br /> Land Account Land Credit Land Total <br /> Facility Accounk Facility Credit Facitity Total <br /> Exempt [] Yes � Na How Determined Totai Amount �_�— <br /> RESOURCE FEE �Rt� <br /> T07ALAMOUNT <br /> Prepared By Checked By <br /> NO CERTIFtCA7E OF OCGUPANCY WIl.L BE ISSUED OR FINAL INSPEC7tON <br /> � PERFORMED UN71L THE 707AL AMOUNTS LISTED NAV� <br /> BEEN PAID AND <br /> RECEIPTED FQR BY A CEhlTRAL PERMITTiIVG OFFICE OF PASC(?COUNTY <br /> Acknowledgement below does nok impiy accaptance of concurrence,but slmply recelpi of a copy oE thfs form,piacing <br /> the buiiding permit owner on notice of thls assessmsni and tha conditions of paymenf for same. <br /> DATE RECEtVED BY <br /> RECEIPT NO, dATE BY <br /> � __�_. --- - <br />