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i, � . 'i <br /> � <br /> � . , ' : P'A�Ct� ��1U�iT'Y, ���RlDA <br /> � � Permit No. l c�� <br /> Date Permitted <br /> Builder Name/Owner Name ��,.f�i.✓tGC�''- ���'i Control# <br /> Caunty Parcei No. �}��-���0��0�?- �0�a SubDiv: _r lUL't��— <br /> AddresslLocation � c.�� �t� � �V . <br /> ClassiflcatioM'ype of Use � <br /> TRAtd5POR7AT10N lMPACT FEE Rate: Sq.Ft Unit: �(��� <br /> � Exempt �Yes [] No How Determined <br /> Impact Fee Amount .$. ,_„�j� �J 2-- � Zane{Vo.' TAZ: <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Famlly Detached House Amount $ -�=�r������ <br /> (057) Mobile Home • <br /> i (058) Other Residentiat <br /> � 123) Collection Fee <br /> Exempt [�]Yes ❑ i�o How Determtned <br /> PARKS AND RECREATION FEE <br /> Land Account �and Credit �and Totai <br /> Recreation Account Recreat'son Credit �Recreatlon Total <br /> Zone , TOTAL AMOUNT $��i 'r'f- 'vr',� <br /> Exempt []Yes ❑ No How Determined <br /> Ll9RARY FEE <br /> Land Accounh Land Gredit Land Total <br /> Faclliry Account Facility Credit Facil(ty Total <br /> Exempt �Yes [] No How betermined Totat Amoun�� <br /> RESOURCEFEE ERU <br /> 70TAL AMOtJNT � <br /> Prepared By Checked By <br /> NO CERTIPlCATE OF OCCUPAWCY WtLL BE lSSUEO OR PlNAL.INSPECTfON <br /> PERFORMED UNTIL THE TOTAL AMOUNT8 L6STED HAVE <br /> BEERI PAID AND <br /> RECEfPTED FOR BV A CENTRAL PEFtM{TTING OFPfCE OF PASCO CQUNTY <br /> Acknawiedgement below does not lmply acceptance of concurrence,hut simpiy recalpt of a copy of thts form,placing <br /> the bufiding permit owner.on notice of this assessment and thq conditions of payment for same. <br /> i <br /> DATE RECEIVED BY � <br /> RECEIPT NO. qATE BY <br />