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� J <br /> �: #�I��CC! CC»JP�TY, FLC�RtDA <br /> .� <br /> .. Permit No. t ���� <br /> Date Permitted /j—�f;� <br /> Buiidar Name/Owner Name c��Yirtl� �C Contrql# <br /> County Parcei No, j) �2�w 2j— bD7d-�(}p100- c�l ov SubDiv: c5'-1 tr��2 d <br /> Address/Location ��t7 _ � �Yv�/'� � i�e �/` <br /> rj <br /> Ciassification/Type ot Use � � t <br /> 7RANSPt?R�"ATION IMI'ACT FEE Rate; Sq Ft Unit: �/ 3��' � <br /> Exempt [� Yes [] No Flow Determined <br /> Impact Fee Rmount $ ���� Zone Na. TAZ: <br /> SCNOOL IMPACT FEE <br /> Account (056) 8ingle-Family Detached Nouse AmaunE $ ��1�?�v- Z-� <br /> (057} Mobile tiome <br /> (058) Other Residential <br /> 123} Caliection Fee 1 <br /> Exempt [�Yes [] No Now Determined I <br /> PARKS AND RECREATION FEE I <br /> Land AccounE Land Credit Land Total <br /> Recreatian Accaunt Recreation Credit Recreation Total <br /> Zone TOTAL AMOUNT $ `T�ii �- cS� <br /> Exempt ❑Yes ❑ No How Determined <br /> LIBRARY FEE - <br /> Lar�d Account Land Credit Land Total <br /> I� Facility Account FaciNty Gredit Facility Totai <br /> Exempt � Yes ❑ No How Determined Totai Amount � <br /> RESOURCE FEE ERU <br /> TOTAL AMQUNT <br /> Prepared By �� r Checked By <br /> NO CER7lFlCATE OF OGCUPANCY WILl.BE ISSUEQ OR FINAL INSFEC710N <br /> AERFORMED UNTIL THE TOTAL AMOUN7S LISTED HAVE <br /> BEEN PA1D AND <br /> REGElPT�p FC?R BY A GEN'TRAt�PERMt1TiNG tyFFiCE t��PASCO CdUN'iY <br /> 1 <br /> Acknowiedgement below daes not impiy acceptance of concurcence,but simp(y recelpt of a copy of this form,plaoing �, <br /> ihe buitding parmit owner on notice of ihis assessment and tha conditions of payment for same. <br /> pqY� REGEIVED BY � <br /> REGEIPT NO. DATE 8Y <br />