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: P',AS�t� �t�tJ�1TV, FL.�f�IDA <br /> ,, . <br /> . .' � Permit No. C �DD� <br /> Date Permitted -1/� <br /> Buiider NamelOwner Nama �,(ih(S�• � Control# <br /> Gounty Pa�cel Na. �J z 2f�2(--!)3�}-(?�Ot'}t7-b34�a SubDiv: �r; tt1� <br /> Address/locatian �"17�� C)��'�u�'/ C.•{�`� <br /> Classiffcatlan(fype of Use IQp�; tP a.X 1�[�',�n� <br /> TRANSPORTATION IMPACT FEE � Rate: Sq.Ff Unit: �� <br /> Exempt [] Yes [� No Haw Determined <br /> ' impact Fee Amount '�t��_ Zone No. TAZ; <br /> SGHCIOL iMPACT FEE <br /> Account (056) Single-Famlly Retached House Amount $ � <br /> (057) Mobila Nome <br /> (058} Other Residenttal <br /> 123) Coitection Fee <br /> Exempt []Yes Q No How Determined <br /> PARKS AND REGREATION�EE <br /> Land Account Land Credit Land Total <br /> Recreation Accaunt Recreatian Credit Recreation Totai <br /> Zone `fOTAL AMQUNT $7(��,,,�(p <br /> �xempt ❑Yes � Na How Determined <br /> ltBRARY FEE <br /> Land Account Land Cradit Land Totai <br /> Facility Account Faoiiity Credit Facttity Tota{ <br /> Exemp# ❑ Yes [� No How petermined Total Amount�� � <br /> RESOURCE FEE ERU <br /> TOTALAMOUNT � <br /> Prepared By � Checked 8y <br /> NO CERTIF{CATE OF OCCUPA[dGY WILL BE ISSUED OR FINAL 1NSP�CTiON <br /> PERFORMED UNTtL THE 70TAL AMDUNTS LtSTER HAVE <br /> BEEN FAID AND � <br /> RECEIPTED FOR BY A CENTRAL PEIZMiTTiNG C?FFICE.OF PASCO GOUNTY ! <br /> �, <br /> Acknowiedgement below daas not impiy acceptance of concurrence,but simpty receipt of a copy of thfs form,piacing <br /> the buAding perrnft owner on notice of thls assessment and th�conditinns of payment for same. f <br /> ; <br /> 's <br /> t <br /> DATE RECEIVED BY � <br /> r <br /> RECEIPT NO. DATE BY k <br /> t . . <br /> . . . .. � <br /> _-�-���-�-n� _____ <br />