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�Asco c�c��rY, �L4R1��4 <br /> ' ' Permlt No. � <br /> � Date Permitt d —���2�r`� <br /> � ; Buiider NameJOwner Name 1�,,.�I,Ytr"r,-- 4=�-.3 L.�(_°. Cantro{# <br /> � , <br /> ' Gounty Parce!No. '��`�—�'��O-(�O�fXI^D6��5ubDiv: ��► �7�t3 <br /> Address/Location cs� �c U�(7 �C..Yt. c�t <br /> , � <br /> CtassifioationlType af Uss � rns <br /> ` TRANSPORTATION IMRACT FEE . Rafe: Sq.Ft tlnit: �,� J��Z� <br /> . Exempt ❑Yes ❑ No Now Qetermined <br /> � tmpact Fee Rmount $. �,�p�J� . Zone No. TAZ: <br /> SCHdOL 1MPAGT FEE <br /> Account (056) S(ngle-Family Detach�d House Amaunt $ ��7�a� � <br /> (057) Mobiis Home <br /> (058} Othe�Residential <br /> ' 123) Cottectlan Fee � <br /> Exempt [�Yes (� No tiow Determfned <br /> i <br /> � " PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Tota! <br /> Recreation Accaunt Recreatton Credit Recreatian Total <br /> Zane T07A�AMQUNT $ L �0�� �� <br /> Exempt �Yes ❑ No How Determined <br /> i LIBt2AFtY FEE <br /> Land AccounE land Credit Lahd 7ptal <br /> ' Faciiity Account Facltlty Credit Facitity Totat <br /> � Exempt ❑Yes ❑ Na How Determined Tatal Amaun� <br /> ; RESOURCE FEE ERU <br /> TOTAL AMOUNT � <br /> Prepared By Checked.By <br /> � NO CERTIFiCATE OF OCCUPANCY WILL BE ISSUED OR FtNAL INSPEGTlON <br /> PERFORMED UNTlL THE 70i'AL AMQUNTS t�1STED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOFt BY A CENi'RAL PERMtTTlNG dFElCE OF PASCO COUNIY <br /> Acknowledgemeat below doss not impiy aoceptance of concurrenoe,but sfmpiy receipt of a copy of this form,placing <br /> ths buitding permit awner on notice of this assessment and the condltions of payment for same, <br /> , DATE RECEIVEQ BY <br /> RECEtPT NO. DATE BY <br />