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1 <br /> . � - . . <br /> i <br />, ,� <br />� < � <br />' . � � �� ��� � _ ��►��o ��►u�°r�r; FL��r�� <br /> ; <br /> � <br /> J � . <br /> - .a , <br /> .» .x+ , ��� � <br /> � Permit No. <br /> �' Date Permi#ted - <br /> Buiider NamelOwner Name e � �� � Contra!# <br /> ; . ,� <br /> County Parcel No. �2f-21--��D��—lk�����.��d SubDiv: ��� <br /> � � r.,--�` <br /> � AddressiLocation ���� �� � <br /> �r r �/ <br /> '� ClassificationiType of Use �?� f� ' �,3 �`� �` <br /> . <br /> � TRAN�PORTATl�N IMPACT FEE Rate: i Sq Ft Unit: � �� <br /> � - 'i <br /> '� , � Exempt [� Yes [� No Now Determined <br /> � lmpact Fee Amount $ ��'��� � Zone No. TRZ: <br /> _ � �� <br /> SCHOOL I�!lPACT FEE � <br /> Accoun# (Q56) Singie-Family Qetached House ; Amount $ , <br /> ` (057) Mobiie Home . j __.__ � <br /> {058) Other Residentiai ' • - <br /> ; <br /> 123} Collection Fee <br /> � Exempt [� Yes [� No How�Determined <br /> E <br /> � E <br /> ' PARK� �►ND REC�EATI4N FEE ! <br /> � Land Account Land Credit `�Land Total <br /> � r � � <br /> .. Recreatian Rccaunt Recreation Credit ! Recreation Total � <br /> I <br /> - Zone � TOTAL AMaUNT $ ��,� `�,� <br /> . ; <br /> ; . . . <br /> Exempt [] Yes (� No How Determined ; � <br /> LlBRARY FEE , <br /> ' Land ,0.ccount Land Credit I Land Tatal � <br /> � <br /> Facility Account Facility Credit ; Facility Tatai <br /> . � <br /> Exempt ❑ Yes ❑ No � Now Determined '� Tofai Amoun� ,� <br /> ,� �� j . <br /> RESOURCEFEE , ERU I <br /> - TOTAL AMOUNT � ' � .. I <br /> ; , <br /> Prepared By Checked By <br /> . . � <br /> NO CERTtFiCp►TE OF �CCUPANCY WILL B� ISSUED OR FINAL INSP�GTI�N <br /> ` PE�'t�ORMEQ UNTI�THE Tt3TAL sAlU1QUNTS LISTED H�0.VE � <br /> BEEN PAiD AND � <br /> I RECE(PT�D FOR BY A CENTRAL PERMI'TTING �DFFICE QF PASGO GOUNTY � <br /> ( ' <br /> ; <br /> Acknowiedgement below does not imply acceptance of concurrence i but slmply racalpt of a copy of thls form, laaing <br /> khe building parmit owner on notice of this assessment and th�conditlons of payment for same. <br /> � <br /> : , <br /> . � <br /> DATE ' RECEiVED BY <br /> " 1 <br /> - RECEIPT NQ. DATE i BY <br /> - '� • <br /> 'i � <br /> � . .. . .. I <br /> � <br /> � _ — - <br />