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. � ' � ���i <br /> , � � <br /> ; <br /> PASC4 CtJ�1NTY, �FLC�RID,�► � <br /> . _ ; <br /> . . ` �_. : Permit No. ���Z q � <br /> � Date Permftted ,�_2�'-/� i <br /> � Buiider NametOwner Name �.Q.�;r' `��+��''"�'� �� Confrol# �� �� <br /> � Gaunty Parcel No. 2�{-2lp-21-DOd0-L)Ot�X7-D 3 �� SubD�v: en J�r���ra�.e.� � <br /> ! �, <br /> AddressiLocation 1�� f�Q OW i tK.- �' <br /> � G(ass(flcation(fype of Use �Yl�_1�._�[� ��2., ; <br /> T— - <br /> TRANSPORi'/1TiON MMPACT FEE . Rate: Sq.Ft Unit: z� 3�� <br /> � Exempt ❑Yes [] No How Determined <br /> � �� � lmpact Fee Amoant $.�t b 3�� Zone No. TAZ: <br /> SCHOOL IMPAGT�EE <br /> Rccount (056) Single-Family Detached House Amount $ �� g7(�. 2°� <br /> � (057j Mobiie Home <br /> • (058} Other Resldentlal <br /> 123) Collectlon Fee <br /> Exempt Yes (� No Haw Determined , <br /> PAEtKS ANd RECREATION FEE <br /> Land Accaunt Land Credlt Land Total <br /> � Recreatian Accaunt Recreation Credit Recreation Total <br /> � Zone TOTAL AMOUNT $ ��l� �� <br /> � Exernpt []Yes [] No How Determ(ned <br /> i ; , <br /> '� LIBRARY FEE� ' <br /> � Land Account Land Credit Land 7otal <br /> , ; ' <br /> iFaciiity Account Facility Credit Faci{ity Totai l <br /> � <br /> , Exempt ❑Yes � No liow Determined Total Amount i <br /> RESOURCEFEE ERU i <br /> �� ` TOTAL AMOUNT � <br /> � 'i <br /> � �. ; <br /> �' � Prepared By Ghecked By <br /> � � 1 <br /> �� NO CERTIFIGQTE OF OCCUPANCY WILL BE lSSUED OR FINAL INSPECTION ' <br /> � PERFORMED UNTIL TNE fiOTA!AMOUNTS LISTED HAVE ' <br /> ' BEEN PA►1D ANQ � <br /> REGEIPTED FOR BY A CENTRAL PERMITTING O�FICE OP PASCO COUNT( <br /> , � <br /> Acknowiedgement beiow does not Imply acceptance of concurrence,but simpty recelpt of a capy of this form,piacing � <br /> the bufiding pertnit owner on noUce of this assessment and tha conditions of paymsnt for same. � <br /> RATE RECE{VED 8Y <br /> RECEtPT NQ. bATE BY <br /> I � , <br /> , . , . .. <br />