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� ' �� `r P�►SGCD CC�1�N�°Y, �FL�1RlCl�► <br /> � <br /> � � Permct No. �� � <br /> - Date Perm�tted �T-T� 1 <br /> , � � ��� I <br /> Bui{der NamelOwner Name t Controt# � <br /> - CountyParcelNo. �3�--�-�-4L��"J-bl��4C7-b`[� SubDlv; C�t'l.�.r�CJ <br /> , � <br /> �5� AddresslLocation oti-t T� � �-� <br /> � <br /> C4assiflcationfi'ype of Use c4+ C t 2 GZ <br /> ��` TRAN36�OR3ATlON IMPACT FEE Rate: Sq.Ft Unit: �,. �id 2.- <br /> �. <br /> f: <br /> �;; Exempt ❑Yes � No Haw Determined <br /> `�� ' Zone No. TAZ: <br /> ;.. lmpact Fee Amount $.�(o�',�_ <br /> �:�: <br /> {::. SCliOS�L IMPAGT FEE <br /> Rccaunt (056) Single-Family Detaahed House Amaunt $ �t�7�-Z-�*° <br /> (Q57) Moblts Home <br /> (058) Other Restdentiaf <br /> 123) Coilection Fee <br /> � Exempt �Yes [�No How Determined <br /> ' PARKS AND REGREATION FEE <br /> Land Acoount Land Credit Land Tatai <br /> Recreatlon Account Recreatian Credit Recreation Total <br /> � Zone 'fC3TAL AMdUNT $ 7& "r'J�,� <br /> �� � Exempt �Yes � No How Determined <br /> ��� LIBRARY FEE <br /> ti�i <br /> Land Account Land Gredit Land Tatai <br /> r Faci4iry Rccaunt Faciliry Credit Facility Total <br /> ` Exempt ❑Yes � No How Determined Total Amount�" <br /> RESOURGE FEE ERU '� <br /> T4TAL AMOUN"C � <br /> Prepared By Checked By <br /> N4 CERT�FICATE OF OCCUPANCY WILI.BE ISSUEQ C!R EI�lA1.1NSPEGTIO�V <br /> PERFORMED UNTIL THE TQ1'AL AMOUNTS�lSTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMlTTINCa O��ICE OF PASCO COUN'f'Y <br /> �`- Acknowledgemsnt balow does notlmpiy acceptance of concurrence,but simpiy racelpt af a copy of thls form,placing <br /> `�' the bullding pecrstlt owner on notica of thla assessment and th�candltians of payment tar same. <br /> S: <br /> DATE RECE{VED BY <br /> RECEIPT NO. DATE BY <br /> _ - _._.._.,._._ _..-�.-�..�_.__r..__- -_ =_..�.� ...._ <br />