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.e.,�_.._ -- -� � � <br /> � <br /> I <br /> i� <br /> , �ID�► � <br /> : P'AS�A �Ctl1R1TY, �Lt�ilR <br /> ,• r , I <br /> ' Permit No. � <br /> Date Permtt#ed �� -�� i <br /> Buildec NametOwner hlame ,�P� �'!G�'" ���YX�SS' �C Cantrol# , <br /> Caunty Parcei No, r�-z�c-zl-6D7D-JJC��r�y��'� SubDiv: S f����-a'�d � <br /> , � <br /> Address/Location (�c,s(c�3 }`-'a�� +d1t1'�� �� <br /> ClassiflcatioNType of Use � /C' �t <br /> TRANSPORTATiON IMPACT FEE� Sq.Ft Unit: �`��f , , <br /> Exempt � Yes ❑ No Flow Detsrmined <br /> � impact Fee Amaunt $.�� ��32� Zane No. TA2: <br /> SCHOOL 1MPACT FEE � <br /> Account (056) Singte-Family Datached Hause Amount $ �, ���� �+ <br /> (057) Mobile Home ', <br /> (458) Other Residentiai <br /> 123) Collection Fee <br /> Exempt �]Yes � Na How Determined <br /> PARKS AND REGREATION F8E <br /> Land Account Land Credit Land Totat <br /> Recreatian Accaunt Recreation Gredit Recreatfion Totai <br /> ' <br /> Zona TOTAL AMOUNT $ �J�f`�.cj�, ! <br /> Exempt [�Yes � No How Qetermined <br /> 3 <br /> LIBRARY FEE ` <br /> Land Accaunt Land Credit Land Total <br /> Faci{ity Accaunt Facilify Credit Facifity Total �, <br /> Exempt ❑Yes [� No Haw petermined ?atal Amoun�� T � <br /> RESOURGE FEE ERU <br /> TOTAL AMOUN7 � <br /> � <br /> Prepared By ��� Checked By <br /> NO CERTIF{CATE OF OCCUF'ANGY WiLL BE ISSl1ED OR EINAL lNSPECTION <br /> PERFORMED UNTlL THE TOTAL AMOUNTS LtSTED HAVE <br /> BEEN PAID AND I <br /> RECEIPTED FOFi BY A CENTRAL PERMI7TING OFFlCE OF PASCO COUNTY ! <br /> � <br /> 1 <br /> Acknowiedgement be(ow does not imply acceptance of concurrence,but sfmpiy receipt of a copy of thls form,placing <br /> 1 <br /> the bu!lding psrmii owner on nat}ce of this assessment and thQ conditions of payment for same. � <br /> RATE RECEIVED BY <br /> REGEiPT NO. DA7E BY � <br /> . ` <br /> ,..... _ - <br />