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`: PASGQ GQUNTY, FLORIDA <br /> .' . Permit No. Z�/v��`�` <br /> Date i'ermitted �=2a L�' <br /> , Builder Name/Owner Name �'�1�--�/U!'"���y+l'�i�-- Contro!# <br /> "��� � �p <br /> � County Parcel No.��-?.�-.2-j-(,X�'�p- C�l�Lt�r�.;(}2 Y�pBubDiv: ,�i U��R�17 <br /> AddresslLocation <�t�'� (�7`�f� /�r�j� �G, <br /> ClassificationlType of Use ` j <br /> : TRAN�PORTATION IMPACT FEE Rate: Sq Ft Unit: �y�__ <br /> Exempt [] Yes (� No How Determined <br /> � Impact Fee Amount $�,�c3�. Zone No. TAZ: <br /> SCNOQL lMPACT FEE <br /> { Account (056} Single-Family Detached House Amount $ ��'�{.2� <br /> ' (057) Mo6ile Name <br /> (058} Qfher Residential � <br /> 123) Co!lection Fee ' <br /> Exempt [�Yes [] No How'Determined <br /> i <br /> � PARKS AND RECREATIQN FEE <br /> ' �and Account Land Credit Land Totai <br /> � Recreatlon Account Recreation Credit Recreatian Total <br /> i � ' <br /> , Zone •� TOTAL AM�UNT $ �/��,��; <br /> i Exempt [] Yes [� No Now Determined � <br /> LIBRARY FEE <br /> Land Account Land Credit Land Tatai � <br /> Facifity Account Facility Gredit Facility Totai <br /> � Exempt ❑ Yes ❑ Na How Determined Total Amaunt`�---- . <br /> RESOURGE FEE ERU <br /> - TOTAL AMOUNI" � . <br /> � Prepared By � Checked By <br /> NO CERTtFICATE OF OCCUPANGY WILL BE ISSUEQ OR FlNAI.iNSPECl'!ON <br /> PERFG?RMED UNTlL THE TO'fA�AMC)UNTS LtSTED HAVE <br /> � BEEN PAID AND • <br /> RECEIPTED FQR BY A CENTRAL PERMITTING OFFICE OF PASCO Ct3t7FtTY <br /> ' Acknowledgement below does not imply acceptance of cancurrence,but simpiy receipt of a copy of this form,plactng <br /> tha butiding permEt owner on nofice of ihis assessment and tha conditions of payment for same. <br /> DATE RECEiVED BY <br /> RECEIPT NO. QATE BY <br />