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------ — I <br /> t <br /> I <br /> . ' : � �tD,�O � <br /> ; PASGO COU4VTY, '�LC�R , <br /> � . , � <br /> ,, <br /> ' "' Permit No. t � � 7� � <br /> Date Permttted � <br /> � <br /> Buitder NametOwner Name !�+-K(�.�✓' �►°""`i°S �� Control# � <br /> � <br /> ��d� �G�- �� ' <br /> CauntyParcelNa. '� '�=Z�O-2)-pQt)D-DObf�Q-63�USubDiv: �J �, <br /> AddresslLacation 3 I 7�J �11/?ti!Lt� !7v j!0� ,�-G�--- i <br /> Glassificatlon/Type of Use ��'1g lP `t�'��ly T��'t.=e- , <br /> TRANSPORTATiON IMPACT FEE Rate: Sq Ft Unit: �.., 37� <br /> Exempt ❑ Yes [� No Fiow Determined . <br /> � Impact Fee Amount $. �, ��Z Zone No. TAZ: � <br /> SCNO�L IMPACT FEE <br /> Account (056) Single-Famify Detached House Amaunt $ ��Z�e•28 <br /> (057} Mobite Home <br /> (058) Other Resfdenttei � <br /> 123} Coitection Fee <br /> Exempt [�Yes Q No How Aetermined <br /> RARKS AND RECR�ATION FEE , <br /> Land Account Land Credlt Land Tota! <br /> � <br /> Recreation Account Recreation Credit Recreation Tatai � <br /> Zone TOTAL AMOUNT $ '��i Q•�5{ , <br /> Exempt ❑Yes ❑ No How Determined <br /> ltBRARY FEE ' <br /> Land Account Land Credit Land Total ' <br /> Facility Account Facilify Credit Facility Tota! <br /> Exempt []Yes ❑ No How Determined Tatal Amount �`____ <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT � <br /> Prepared By � Checked By ( <br /> i <br /> � <br /> NG?CER7IFICATE OF OCCUPANCY WILL BE ISSUED OR FlNAL(NSAECTION � <br /> PERFC?RMED llNTi�THE TOTAL AMI�UNTS LIS7ED NAVE <br /> BEEN PAtD AND ; <br /> RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCd COUN'!'Y <br /> � <br /> , <br /> Acknowiedgement below does not impiy acceptance of concurrence,but simpty receipt of a copy of this farm,piactng + <br /> khe building permit owner on notica of thls assessment and thQ condltions of payment for same. <br /> DATE RECEtVED BY <br /> RECEIPT NO. DATE BY <br /> ,�.__._------------ ---- __. <br />