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__� <br /> � �, <br /> 'i <br /> � = PASCC} COUf�TY, F�t�RtDA <br /> , <br /> . .. Permtt No. d ��g <br /> Date Permi�ted ,� --/____7-1.?�^ <br /> Builder NametOwner Name �VtLzh'�'�Yne �.[.-� Cantroi# <br /> Gounty Parcei No. ' -'�-2-�-UDqO �-�O�Z� SubDiv: �Sp((,{'p���2y-� <br /> Address/Lacation ��,,,_8 (o l�.n{�(,,�CitP� �t�a�c�� __ <br /> ClassiflcatfoM"ype of Usa �i�tP �"�''''t��-f__ <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: Z�OC�J <br /> Exempt []Yes [] Na Ho�nr Determined <br /> � lmpact Fee Amount $. v�- ��232• Zone No. TAZ: <br /> SCHt10L IlU1PAGT FEE <br /> Account (056) Singfe-Family Detached Nouse Amount $ �1��lo• 2�3 <br /> (057) Mobtle Nome <br /> (058) Other Residential <br /> 123) Gollectlan Fee <br /> Exempt []Yes ❑No How Determ(ned <br /> PARKS AND RECREATit3N FEE <br /> Land Account Land Credit Land Totat <br /> Recreation Account Recreatian Credlt �Recreatton Tota! <br /> Zone TOTAL AMOUNT $ Z(�`���� <br /> Exempt (�Yes ❑ Na Haw Determined <br /> LIBRARY FEE <br /> �and Accaunt Land Credit Land Totat <br /> Facillty Accoun# Faciitty Cred(t Faciitty Total <br /> Exempt ❑Yes ❑ No How Determ{ned Tota(Amou���=- <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT � <br /> Praparad By ' Checked By <br /> NO CERTtFiCATE OF OCCUFANCY WILL BE ISSUED OR FIMAL 1NSPECTION <br /> PERFQRMED UNTIL THE TOTAL AMOUNTS LISTED HAVE <br /> SEEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMITTING lJFFICE OF PASCO COUN'TY <br /> Acknowladgement befow doas not impiy acceptance of concurrence,but sfmpty racelpt of a aapy of thfs form,piacing <br /> , the buliding parmit ownar on notice of this assessment and thQ condittons ot paymant ior same. <br /> DATE RECEIVED BY <br /> RECEfPT NO. DATE BY <br /> ; <br /> . � I <br />