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� <br /> , � ' PASGO COUNTY, �L4RIDA � <br /> � . <br /> . s , . <br /> ' . ..,.� � <br /> Perrnit No. ��_�� , <br /> Date Permitted �_ ' <br /> = Buiider Name/Owner Name �vP.,rlt�tl.t-✓��"�� �-x-L.� ConErol# <br /> County Parcel No.Z�-2�—�_UDL�--���}-1S�t�'? SubDiv: ��.f�t 1��j��� <br /> AddressiLocation 3� � � �-- <br /> CiassificafionlType of Use Ji�'ti'j tp � � <br /> TRANSPORTATIOM IMPAC7 FEE • Rate; Sq.Ft UNt: �c 3'��, � <br /> Exempt [� Yes [] No Mow Detertnined <br /> , � Impack Fee Amoant , $�� �O�3Z Zone No. 7AZ: <br /> � SCHt30![NIPAGT FEE � <br /> � Account (056) Singie-FamUy Detachad House Amount $ �-y��?(�,-2�y° <br /> (057) Moblte Nome <br /> , (058) Other Restdenttal <br /> 12$� C�II8Gt14C!F8@ <br /> ; Exempt [�]Yes [� No Naw Determ[ned <br /> PARKS AND REGREATION FEE <br /> 4 Land Account Land Credit Land Total <br /> ', Recreation Accaunt Recreation Credit Recreatian Tota} <br /> Zane TOTAL AMOUNT $ �r2q•�� <br /> Exempt [�Yes [] No How Determ(ned <br /> •LiBRARY FEE � <br /> � I�Land Account Land Credit Land Totai � <br /> . Facility Account Facility Credit Fac�lEty TotaV � <br /> Exempt [] Yes ❑ No How Determined Tota[Amount c�`� <br /> , <br /> 12ESOURCE FEE ERU <br /> �Tl�TA�AMOUNT � <br /> ' Prepared By a Cheaked By � <br /> I <br /> N�CERTtPtCATE OF OCCUPAEfCY WiLL BE ISSUED OR FINAL fNSPECTtON <br /> ` � PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE �� <br /> BEEN PAIQ AND � <br /> REGEIPTED FOR BY A CENTf2AL PERMITClNG OFFICE OF PASCd COUN'TY � � <br /> � <br /> � 1 <br /> Acknowledgement beiaw does not tmpty acceptance of concurrence,but stmp[y recelpt of a copy of thfs form,placing <br /> the building permit owner on notica of thls assessment and tha condttions of payment for sama. ' <br /> �I ` RATE RECEIVED BY <br /> i <br /> RECEIPT NO. DATE BY <br /> � <br /> ` . . . ,. ' <br />