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. P�4SC0 COIDNl'Y, �LORIDo4 <br /> Permit No, r 8��� <br /> � Date Permitted Z _ <br /> Builder Name/Owner Name �,,, c�s�(_� <br /> Control# <br /> County Parcel No, b5-Z-lo-Z(-OD?p_ <br /> ��^� � SubDiv: �' �� <br />, • Address/Location (� ap�� ���� �� <br /> Classification/Type of Use ��y �,� � i�w <br /> � <br /> TRANSPORTATION IMPACT FEE . <br /> Rate: Sq Ft Unit: 3��_ <br /> Exempt � Yes [ No How Determined <br /> � Impact Fee Amount $. 3�(�32, <br />� — Zone No. _— 7�: <br /> SCHOOL IMPACT FEE �— <br /> ; Account (056) Single-Family Detached House <br />, , (057) Mobile Home Amount $ 4�� , Z� <br /> (058) Other Res(dential <br /> 123) Collecti <br /> on Fee <br /> Exempt [� Yes [� No How Determined <br /> PARKS AND RECREA710N FEE <br /> Land Account Land Credit <br /> __ Land Total <br />, Recreation Account <br /> �_ Recreation Credit <br /> � ___�Recreation Total �_ <br /> Zone <br /> , � TOTAL AMOUNT $ �(��. S� <br /> Exempt [] Yes �] No How Determined � ' <br /> L�BRARY FEE I <br /> Land Account Land Credit <br /> Land Total <br /> , Facility Account <br /> __ Facility Credit ' <br /> Facility Total <br /> Exempt ` � Yes � No How Determined <br /> � � Total Amount G�_ <br /> RESOURCE FEE <br /> TOTAL AMOUNT ERU <br /> Prepared By � <br /> Checked By <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUEb OR FINqL IIdSPECTION <br /> PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE <br /> RECEIPTED FOR BY A CENTRAL�P RMI IT7WG OFFICE.OF PASCO COU <br /> N7Y <br /> Acknowledgement below does not Imply acceptance of concurrence,but simply receipt of a copy of this form,p�acing <br /> the building permit owner on notice of this assessment and thQ conditions of payment for same. <br /> DATE � <br /> RECEIVED BY <br /> RECEIPT NO. �_ pATE � <br /> �_ BY <br />