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, I <br /> -- , <br /> � � `: PA��t� �t�Ut�TY, Fk.+�f��D.�4 <br /> k ' ' <br /> � Permtt Na, f �� � <br /> Date Permitted � <br /> , <br /> Suilder Name/Owner Name �.��illtt�"' ���5'l.LC.- Gantral# � <br /> �Courity Parcel Na ��2�_p�7a�-Ov��L?3rt� SubDiv: �'�,�j�� �I <br /> Address(Locatian 3��� ��/'e ��`! � 5'-(�-- � <br /> f ( <br /> 'Classificatfon/Type of Use �i� �� t <br /> �'fRAN�POR7AT10N IMPAGT�FEE Rate: Sq.Ft Unit: 2���7(,, <br /> i <br /> � �� •Exempt ❑Yes ❑ No How Determined ! <br /> � ,impact Fee Amount $ c�i ��2� Zone No. TAZ: �� <br /> , <br /> 'SCHdOL tMPACT FEE ``�.���rr--������1�� C� <br /> ;Account (056) Single-Fam(!y Detached House Amount $ �i��,G�7��� , <br /> • {057) Mobile Home <br /> � <br /> (058} Other ReSfdentiai � - ' <br /> 123} Cofleetion'Fee ' ' <br /> �Exempt [�]Yes Q No � How�Determ(ned �� <br /> . ; <br /> � ;PARKS'ANQ RECREATION FEE i <br /> ;�and Account Land Gredit Land Tatai � <br /> , <br /> ' 1 <br /> _ � ��Recreafion Account Recreatian Credit Recreatian Totaf i <br /> . 2bne TQTALAMOUNT $ 76.�-��a '� <br /> ;Exempfi ❑Yes [] No How Retermined � <br /> 'L18RARY FEE � ' <br /> Land Account Land Credit Land Total � ' <br /> F'acility Accaunt Faciliiy Credit Fac(Iiry Totai , <br /> Exempt {]Yes ❑ No How Determined Tota1 Amount-�� � <br /> � 'RESCIURCE FEE ERU ` <br /> - .1'OTAL AMdUNT ' ,. <br /> I�repared By Checked By <br /> N4 CERTIFICATE OF OCCUPANCY W1LL BE lSSUED 06t FINAL INSPECTION <br /> `; PERFORMED UNTIL THE TOTAL AMOUlNTS LISTED HAVE <br /> , BEEN PAlD AND �I <br /> RECEIPTED FOR BY A CEIVTRAL PERMITI'ING OFFiCE OF PA5C0 COUl+!'CY <br /> � <br /> Acknowiedgement betow doea not tmply acceptanca of concurcence,but simpiy racetpt of a copy of thls form,plecing � <br /> the buiiding permit owner on nottce of ihls assessment and ths condfttons of paymenE for same. i <br /> aATE FtECE{VED BY <br /> RECElPT NO. DATE BY <br /> . . .. , ' � <br /> ���n <br />