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I �di�{1��� ����� ll ' ������� II <br /> di—{1 <br /> ' Permit No. � Z�3 7 <br /> ' Date Parmitted /-3D- <br /> Builder Name/Owner Name � � �707��C Control# <br /> County Parcel No, Q�-Z(�—Z�- nO�O-�(��oG�(�7l77�SubDiv: �� lixaztGiU <br /> , Address/Location 7 9 (,t,/ ,/in i�1�4/t�, �'�- -f-- <br /> r� ClassiflcatlonlType of Use _ cS�`►19 IP �`G� <br /> ;�� <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: � � <br /> • Exempt � Yes � No How Determined <br /> c. <br /> � Impact Fee Amount _ $. �(,3 2• (S� Zone No. TqZ; <br /> i. <br /> ;'-; SCHOOL IMPACT FEE <br />' . Account (056) Single-Family Detachad House Amount $ _ �(�7�, Z� <br /> (057) Mobfle Home <br /> � (058) Other Resldentlal <br /> 123) Collection Fee <br /> Exempt Yes Q No How Determined <br /> PAR6LS APlD RECR�ATION FEE I <br /> Land Account Land Cred(t Land Total ' <br /> I Recreation Account Recreation Credit �Recreation Total <br /> li <br /> ' Zone TOTAL AMOUNT $ `7 (D 9, c7� <br /> Exem t Yes � � <br /> p ❑ ❑ No How Detarmined <br /> ' LIBRARY FEE <br /> � Land Account Land Credit Land Total <br /> ` Facility Account Facility Credit Facllity Total <br /> Exempt � Yes � No How Determined Total Amoun <br /> RESOURCE FEE ERU - <br /> TOTALAMOUNT <br /> Prepared By Checked By <br /> PIO CER7IFICATE OF OCCUPAiVCY WILL BE ISSUED OR FINAL INSPECTIOPI <br /> PERFORMED UNYIL THE T07AL AMOURl7S LISTED HAVE <br /> � BEEN�AID AND <br /> RECEIPTED FOR�Y A CEPITRAL PcRIUiITTING OFFICE OF PA►SCO COUfV1V <br /> - Acknowledgement balow does not Imply acceptance of concurrence,but simply recelpt of a copy of this foRn,piacing <br /> the bullding permlt owner on notice of this assessment and thQ condiQons of payment for same. <br /> QATE RECEIVED BY <br /> RECEIPT NO. DATE gy <br />