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1 <br /> . i <br /> i <br /> ' � � <br /> , , �A�CCa ��UNT'Y, FLC)RIDA <br /> � <br /> � , . <br /> � .. Permit Na. / �t� . <br /> Date Permitted �2- J <br /> ` Builder NameiOwner Name �Wl�.r ��rn� ��k..� Control# <br /> � County Parcel No. - -.�-60�d--D r�-D ,?�'J SubDiv: , //�rztG�Il <br /> � <br /> �� AddresslLocation ���� �""Ct(,��7 ���'�l �� <br /> , GlassificationCCype of Use �J���'�e 7�t�/ <br /> TRANSPORTATION IMPACT FEE Rafe: Sq Ft Unit: �,�� <br /> IExempt [� Yes [� No How Determined <br /> iImpact Fee Amount $ ��..3�� �� Zone(Vo. TAZ: , <br /> � SCHQOL IMPACT FEE <br /> � Accaunt (056) Singie-Family petached Hause Amaunt $ � �?�P •_Z'�' <br /> � � (057} Mobile Nome <br /> i (058} Other Residential • <br /> � i� 123) Collection Fee <br /> Exempt � Yes Q Na How'Determined <br /> � � PARKS AND RECREATION FEE <br /> � � Land Account Land Credit Land Tofal <br /> . ��Recreation Account Recreation Credit Recreation Tota! <br /> . � - <br /> � � I Zbne . � TOTAL AMOUNT $ 7�, t• cJ,� <br /> � � . . <br /> � Exempt � Yes ❑ No Naw Determined � <br /> � <br /> , � LIBRARY FEE <br /> � Land Account Land Credit Land Tota! � <br /> � Facility Account Facllity Credit Facillty Totai <br /> i <br /> ' f Exempt [] Yes ❑ Na How Determined Totai Amoun� <br /> � RESQIlRCE FEE ERU <br /> � TOTAL AMOUNT <br /> :. <br /> � <br /> � I Prepaced By � Checked By <br /> NO CERTIFICATE C3F OCCUPANCY WILL BE ISSUEQ OR FINAL INSFECTION <br /> PERFORMED UNTIL 7HE Tp7AL AMOUNTS LlSTED HAVE <br /> F , I BEEN PAID AND <br /> RECEIPTED FOi2 BY A CENTRAL PERMlTTING OFFIGE(?F PASC!?CC}UN't'Y <br /> � <br /> � Acknowladgement below does not Imply accapkance of concurrence,but slmp{y:eceipt of a copy of this form,piaoing <br /> � the building permit owner on notica af this assessmant and the,condltlons of payment for same. <br /> I <br /> ! <br /> �- , <br /> { DATE RECEiVED BY <br /> I <br /> i RECEiPT NO. DATE BY <br /> I ' <br /> , � <br /> � , <br /> , <br /> � <br />