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��t„�'{'� <br /> ���`� • <br /> .; � <br /> ; <br /> :,_ � �J�E��� ������i '���lv��!"� <br /> . . .R'' � � <br /> �?t�—�� Permlt No, ��_______.� <br /> � -� �t 3 Date Permitted /2- C 8—!? <br /> G2�� � _ <br /> Builder Name/Owner Name ��r `��.� �.��7'�.eU��i'c� Con#rol# <br /> County Parcel Na. t3�-2�7..�—Qf��..UC�O.- .3� �� SubDiv: �r2�.� �1t���� <br /> Address/Lacation C� �� �Yt�e.- `�� ��` c�t� <br /> Ctassificatlon/Type of Use /i/���:�f�. �.�.�t,. <br /> TRANSP4RTATION IMPACT FEE Rate; Sq Ft Unit: � ''l�� T <br /> Exempt ❑ Yes ❑ No Haw Determined <br /> � Impact Fee Amount $. .�� � ��- Zone No. TAZ: <br /> SCHOOL IMPACT �EE � <br /> Account (056) Single-Family Detached House Amount $ ���� <br /> (Q57} Mabile Home <br /> (058} Other Residentiai <br /> 123} Cc�llection Fee <br /> Exempt [] Yes [] No Haw Determined <br /> PARKS ANC► RECREATit3N FEE <br /> Land Accaunt �and Credit t�and Tatat <br /> Recreation Account Recreation Credit Recreation Total <br /> �one T�TAL AMOUNT $ �2� • � 3 <br /> Exempt (� Yes [] No How Determ{ned <br /> LIBRARY FEE <br /> Land Account �and Credit Land Tata! <br /> Facility Account Facility Credit Facility Total <br /> Exempt {� Yes ❑ Na How Determined Totai Amoun�`Z��� <br /> RES�URCE FEE ERU <br /> TOTAL AMOUNT � <br /> Prepared By � Checked By <br /> NO CERTIFICATE OF OCCUPANCY it!!!LL BE {SSUED OR FINAL INSPECTIQN <br /> PER�ORMED UNT!!.THE TOTAL AM�UNTS 1.IST�D NAVE <br /> BEEN PAtD AND <br /> RECEIPTED F+C�R BY A CENTRAL P�RMITTING �?FFICE�OF PASCO C4UtdT1( <br /> .` <br /> Acknowledgement below does not lmply acceptance of concurrence,but slmply recelpt of a copy af this form,piacing <br /> fhe butlding pecmit owner on natice of this assessment and the,conditions of payman#for same. <br /> � <br /> DATE RECE{VED BY <br /> � RECEIPT N0. DATE BY � <br /> I �, <br /> ` . . . .. !� fi <br />