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f � <br /> + A <br />` � . � _ PASGO G(�UN1`Y, FLt�RIDA <br />` �; .. .. <br />, Permit No. ��j �b <br /> Date Permitted 3-�a-(Z <br /> Builder NamelOwner Name l�:P...r/�.lilGt.r l�T�J�`�'�.. Cantroi# <br /> County Parce!No. ��-Z�-2(-b(�`7Q-QZ1�L'0- (3I�D SubQiv: cSr �1�'��� <br /> AddresslLocation ��/ ��Gt� �12�-�e.�/ c.s�' <br /> C[assiflcationlType of Use v�`��j r� `~�-m,�� �1Y►�._ <br /> ' TRANSPOR7ATION IMPACT FEE Rate: Sq Ft Unit: �� ('�3� <br /> , Exempt � Yes � No Now De#ermined <br /> I � Impact Fee Amount $ c��c�2.G�?� Zone No. TAZ: <br /> ' SCH00l.lMPACT FEE 2� � <br /> Account (056) Single-Family Detached House Amount $ , '7�r1�r <br /> '�i ' (Q57) Mobile Nome <br /> (d58} �ther Residential • <br /> 423) Callectian Fee <br /> � Exempt [] Yes [] No � How�Determined <br /> � � PARKS AND RECREATION FEE <br /> Land Accaunt Land Credit Land Total <br /> • Recreation Account Recreatian Credit Recreation Tofal <br /> � one Tt�TAL AMOUNT $� yJ fa�•�j� <br /> - �Exempt ❑ Yes (� No Haw Determined <br /> IBRARY FEE <br /> and Accaunt Land Credit Land Totai � <br /> � � acility Accaunt Fecility Credit Facility Totai <br /> �I <br /> xempt [� Yes ❑ Na How Determined Tatai Amauntr�__ <br /> ' ESQURGE FEE ERU <br /> � - ; OTAL AMOUNT ' <br /> j repared Sy Checked By <br /> NO CERTIFICATE OF OCGUPANCY WfLL BE ISSUED 012 FINAL{NSPECTtON <br /> PEFtFOi2MED UNTIL THE TOTAL A1IAOUNTS LISTEU HAVE <br /> � BEEN PAlD AND <br /> I RECElPTED FQR BY A CEN7RAL PERMITTtNG OFFtCE OF PASCO COUNTY <br /> �I <br /> ` cknowledgemant be(ow does not impiy aeceptance of concurrence,but slmply recelpt of a copy of thls form,placing <br /> i the butiding perm(f owner on notice of this assessment and khQ conditions of payment for same. <br /> I <br /> ATE RECEIVEp BY <br /> ECEIPT NQ. DATE BY <br /> r,_..,-,,.�,�-�,� —" _ <br />