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� � ' , P'�►��� �QU1V1'Y, FLC}RI1�A � <br /> . - - Permit Na. �C3 �fp <br /> Qats Pacmifted ��'7 � � <br /> 8uilder NamelOwner Name ���-nQ r'" t�''`�'s��Cantrol# ' <br /> . ( <br /> �Courily Parcei No. t��'�-2�(-p0��^�2.�-Ol� D SubDlv: �! !G{'f�� <br /> AddresslLocation ��p�b �1�-v tC' (�5.�t�t�`�'�- <br /> � / <br /> 'ClassificationtType of Us� �' �� / ' <br /> �TRANSPOR7ATION IMPACT FEE Rate: 8q-Ft Unit: 2r v�cS� ' <br /> ` �� ;Exempt ❑ Yes ❑ No Now Deferm3ned <br /> � ,Impact Fee Amounk $ Zane No. TAZ: <br /> � � � <br /> �SCHOOL tMPAGT FEE I <br /> Account (Q56) Singie-Family Detached Hause Amount $ �-�Q7(v-2.-� , , <br /> � (057) Mobile Home ' <br /> , (U58) Other Resldentla! � - ��, <br /> 123) Colleetfon Fee � � 1 <br /> iExempt [�]Yes []�!o � How:Determtned � <br /> , � <br /> ' iPARKS AND R�CREATIt?N FEE � <br /> ;Land Accaunt Land Credit Land`fotat '� <br /> • ��Recreation Account Recreatian Credlt Recreatian Total • i <br /> . . . <br /> . �ZOne � TOTAL AMOUNT $ '7�I f cS,6 I <br /> �,Exempt ❑Yes ❑ No How Determined : <br /> � <br /> 'LtBRARY P�E <br /> Land A�count Land Credit Land Tota! -�J � <br /> �aciiity Account Facility Credit Facil(ty Totai ' <br /> . �� <br /> � Exempt ❑Yes ❑ No How Determined Total Amount � ' <br /> RESOtlRCE FEB ERU <br /> - TOTAI�•AMQUNT ' � .. , , <br /> - � . �f <br /> I'repared By Checked By � <br /> Na CERTtF[cA7E O�OCCUPANCY WtLL BE ISSUED OR FINAL tNSPECTtON <br /> PERFORMED UIVTIL THE TOTAL AMOUNI'S LiSTED HAVE , <br /> . SEEN PAID AND i <br /> RECEIPTEp FOR BY A CENTRAL PERMITTING t�FFiCE OF PASCO GGIUNTY <br /> I <br /> Aoknowledgament below does not Imply acceptance of concurrenoe,6ut simply recalpt of a capy of this farm,piactng , <br /> the buiidtng permit owner on notice of this assessment and fhQ conditlons of payment for same. <br /> DATE RECE{V�D BY I <br /> R�CEIPT NO. DATE BY <br /> _ �-�--.�- <br /> � �-.� �:-_.,r.�__.-_�.._� <br /> l <br />