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� ° : PASCQ C�UNTY, FLORIDA <br /> ` .. ., Permit No. _� tJ <br /> Dafe Permitted --�,��2��. <br /> Builder Name/�wner Name ���-f' ��r�'i�`P�S �-h,..t.�- Cantrof# <br /> County Parce{No. �y—�p?�—(7D7t5-t5b(pp-b3Y't� sub[�iv: c5 c ,��J�� I <br /> AddresslLocation �� � �� a.a�c t� �tf�.Y�-- �`� � <br /> I, CtassJficattonlType of Use o�i ( �I���,e'.-m,c t � <br /> I �f <br /> � TRANSPORTATION IMPAGT FEE Rate: Sq.Ft Unit: ��`t_� �' <br /> �I <br /> �li Exempt � Yes � No How Determined <br /> I � Impact Fee Amount $3, �13Z, � Zane No. TAZ; <br /> i <br /> � SGNQOL lMPAGT F8E <br /> Rccount (056} Single-Family Detached House Amount $ �,� 7� � Z� <br /> (Q57} Mobile Home <br /> ' (058} Other Residential <br /> I 123) Collection Fee <br /> Exempt []Yes [� Na How Determtned <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit �and Totai <br /> � Recreation Accaunt Recreation Credit Recreafion Total <br /> Zone TOTAL AMOUNT $ �(��-V�,b <br /> Exempt [] Yes C1 Na How Determined <br /> !.lBRARY FEE <br /> Land Account Land Credit Land Total <br /> � Facility Account Facility Gredit Facility Totai <br /> , Exempt [] Yes [] No Now Determined Totai Amou�4�--� <br /> i RESOURGE FEE Ei2U <br /> l"OTAL AMOUNT <br /> � Prepared By r Checked By <br /> NO CERTIFiCATE OF OCCUPANCY WILL BE ISSU�R OR FlNAL lNSAEGTION <br /> �, PEFtFORMED UNTlL THE TOTAL AMC)UNTS USTED HAVE <br /> � BEEN PAIQ AND <br /> RECEIPTEp FOt�BY A CENTRAL.PERMITTING C?FFICE OF PASCO COUNi'Y <br /> Acknowledgement below doss not lmply aceepkance of coneurrence,but simply receipt of a copy of thls fo�m,piacing <br /> the buiidEng psrmit owner on notice of tfiis assessment and the conditions of payment for sama. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br /> , <br />