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� � P/�SCO COIJR�TI(, �LORIDA . <br /> , , , <br /> Permit No, l��(��j <br /> / � Date Permitted a_�l• <br /> Builder Name/Owner Name ��g/ <br /> � Control# <br /> County Parcel No, _%�yZ(o_�/ �� � ���v <br /> SubDiv: � <br /> Address/Location 3 7 90c� �yy e �j� L <br /> Classification/Type of Use - �7��� <br /> � <br /> TRANSPORTATION IMpAC'P FEE . <br /> Rate: <br /> Sq Ft Unit: �Z Z <br /> Exempt [] Yes � No How Determined <br /> � Impact Fee Amount � <br /> $� �' ��Z b� Zone No. <br /> SCHOOL IMPAGT FEE T�� �-- <br /> Account (056) Single-Family Detached House <br /> (057) Mobile Home Amount $ <br /> (058) Other Resfdentfal <br /> �123) Collection Fee <br />� Exempt Yes a No How Determfned <br /> PARKS A(dD RECREATION FEE ' <br /> Land Account <br /> Land Credit _ Land Total <br /> Recreation Account <br /> �_ Recreation Credit <br /> �_ Recreation Total <br /> Zone �_ <br /> � TOTAL AMOUNT $ 7�0��'� <br /> Exempt � Yes � No How Determined � <br /> LIBRARY FEE <br /> Land Account <br /> Land Credit <br /> Land Total <br /> Facility Account <br /> `� Faciliry Credit • ' <br /> Facility Total � <br /> Exempt � Yes � No How Determined I <br /> � Total Amount � � <br />' RESOURCE FEE <br /> TOTALAMOUNT ERU <br /> Ii Prepared By � � <br /> Checked By ' <br /> Id0 CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTIOfV � <br /> PERFORMED UNTIL THE TOTAL A1VIpUfV7S LISTED HAVE � <br /> RECEIpTED FOR BY,4 CENT ALEP RMI7'T NG OFFICE OF PASCO COUNTY <br /> ' I <br /> i � <br /> Acknowledgement below does not Imply acceptance of concurrence,but simply recelpt of a co <br /> the bullding parmit owner on notice of this assessment and thQ condit . <br /> lons py of this form,placing <br /> of payment for same. <br /> RATE ; <br /> RECEIVED BY j <br /> RECEIPT NO. — pATE ' <br /> _� BY � <br /> . , I <br /> �.�,_,_ �..--- — � <br />