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, � � PAS�O �C>l1[VTY, FLt�E�lC►A <br /> � ' ` � Permit No. <br /> , Date Permitted Z Z _,f,� <br /> Builder Name/Owner Nama �d��r� ��C�^� Cantroi# <br /> Gaunty Parcel No. ��—�a—`Z-�—OQ?p..�}ptpp-.p332� SubDiv: J�'� t�_d7� <br /> AddresstLocation 3�pb�� �`��`� ��lt�• `''"""�- <br /> CiassificationtType of Use ��Yt q��Q�.�(� <br /> . ' <br /> TRANSPORTATION IMPACT FEE • Rate: Sq.Ft Unit � �.3 <br /> Exempt []Yes [] iVo How determined <br /> � Impact Fee Amount $. ��, (r��32� Zone No. TAZ: <br /> SCHO4L IMPAGT FEE <br /> Account (056) Single-Family Detached House Amount $ �, ��.�t � <br /> {057) Moblle Home <br /> {058) Other Res(dentiel <br /> 123) Coilection Fee <br /> Exempt [�Yes ❑ No Haw Determined <br /> RARKS AND RECt2EAT1(1N FEE <br /> Land Accaunt Land Ccedit Land Totat <br /> Recreation Account Recreation Credit Recreatior►Tota{ <br /> Zone TOTAL AMOUNT $ ��- �S� <br /> Exempt [�Yss [] No Haw Determined <br /> LIBRARY FEE <br /> Land Account Land Credit Land Total , i <br /> Facility Account Faeiifty Gredit Facility Totai � <br /> Exempt ❑Yes ❑ No How Determined Total Amou� <br /> RESOURGE FEE ERU <br /> TOTAL AMOUNT <br /> Prepared By Checked By <br /> NO CERTIFtCATE OF CICCUP'ANCY W{LL BE ISSUED CiR FfNAL{NSPECTfON <br /> PERFORMED UNTiL TNE TOTAL AMOUM7S LISTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A CEN7RAL PERiVIiTTING OFFICE OF PASCO COUNiTY <br /> Ackn,owledgement below does not impiy acceptance of connurrence,but sfmpiy receipt of a capy of this farm,placing <br /> the buifdfng permit owner on notice of this assessment and thQ condittons of payment for same. <br /> DATE RECElVED BY <br /> RECEIPT NO. DATE BY <br /> , -- <br /> ----r----_�...._.�..:.__._�.�---��-,—______- <br />