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� � <br /> .. �'�, <br /> �; <br /> ; = :.. Y% 1°"�'11��� �la��� i � �I��l���� <br /> .,., . <br /> r' <br /> ., .� _ Permlt No. ! �'��J`� <br /> Date Permitted ��.�.�(_ <br /> Builder Name/0wner Name � �r-y'(. ���`'7ncG.�i� Control# <br /> i J �=a�--- <br /> County Parcel No. ��� ,2�^ Z/—j��j1 �"b��—�,�7� SubDiv: / :� <br /> AddresslLocation �7c:31J S� � �'Y'� ,�� ..S' <br /> � <br /> ClassificationiType af Use ,e t�S� �(,���C,� <br /> TRANSP�RTATlON II�IIIPAGT FEE Rate: Sq Ft Unit: <br /> Exempt [] Yes � No How Determined <br /> � lmpact Fee Amount $c36�� � Zor�e Na. TAZ: <br /> SCHOQl. IMPACT FElE <br /> Account (056j Single-Family Qetached House Amount $ _`����~ <br /> (057) Mobile Home <br /> (058) Other Residential <br /> 123) Copection Fee <br /> Exempt Yes [� No How Determined <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Tota! <br /> Recreatian Account Recreation Credit Recreatian Total <br /> Zane TOTAL AMOUNT $ ��f• �5,� <br /> Exempt C] Yes [�] No Haw Determined ' <br /> �IBRARY F�E <br /> Land Accaunt Land Credit Land Total <br /> Facility Account Faciiity Credit Facility Total <br /> Exempt � Yes [� No Haw Determined Tatal Amout4�� <br /> RESOURCE FEE ERU <br /> TUTAL AMOUNT <br /> Prepared By ' Checked By <br /> N(? GEFtTIFICATE QF t)CCUPANCY WILL BE ISSUEb OR FINA� INSpECTION <br /> PER�QRM�D UNT!!.THE`fQTAL,AMflUNTS I.iSTED NAVE <br /> �EEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMITTING CIFFICE OF PASCO COUNTY <br /> Acknowledgement beiow does nof impiy acceptance of concurrence,but simply recelpt of a capy of this form,placing <br /> the building permit awner on nafice of tFris assessmenf and fhe canditions of payment far same. <br /> DATE RECElV�D BY <br /> R'�CEIPT NO. DATE BY <br />