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� � <br /> : �ASCI� ��IJ[UTY, FL�RI��► <br /> � Permit No. �7 ��. <br /> - Date Permitted __� <br /> Builder Name/Owner Name ���CT��"��l��' \ Control# <br /> = County Parcei No. (�S-�"`Z'�QvGu^�v�'t?G"��BubDiv: ��}lG�.r�cG1f) <br /> AddresslLocation �P� 6 Y' � /�Wtl <br /> ��, C4assiflcat{onli"yps of Use c�'��`� n <br /> ti� TRANSPORTA'[IQN IMPACT FEE Rate: Bq.Ft Unit: �-� ,3tp �--- <br /> ;t <br /> y' Exempt �Yes � No How Detecmined <br /> � lmpacf Fee Amount $. 3�3�-' Zone No. TAZ: <br /> 4�. <br /> t„; SCHOOL INIPAGT FE� <br /> - Account (056) Single-Family Datached House Amount $ �g ��p-� <br /> '�' (067) Mobile Home <br /> {058} Ofher Resldentiat <br /> 123) Collection�ee <br /> Exempt [�Yes Q No How Determ[ned <br /> PARKS AND RECRE,4T18N FEE <br /> Land Account �and Crec3lt Land Totat <br /> Recreatian Account Recreation Credit �Recreatfon Total <br /> Zone TOTAI.AMOUNT $ _Zto`�- �� <br /> � Exempt �Yes � Na How Determined <br /> LkBRARY FEE <br /> ;;: - <br /> Land Acoount Land Credit Land Tota! <br /> Facllity Account Faciltty Credit Facility Total <br /> ,� Exempt [] Yes ❑ No How petermined TQtal Amount �� <br /> RE80URCE FE� ERU " <br /> TO'CAL AMOUNT ' <br /> Prepared 8y a c�� _� Checked By <br /> NO CER7IFICATE OF OCCUP.4PlCY WILL BE ISSUEp OR FINAL INSPECTION <br /> PERFORMED UNTiL THE TOTAL.AMOUNTS LiSTED HAVE <br /> �EE�i PAID AAli} <br /> RECEIPTED FOR BY A CENTRAL PERMITTlNG OFPICE OF PASGO CQUN7Y <br /> Acknowledgement below daea not(mply acceptance of concnrrenoe,but simply recelpt of a copy of tttls form,piacing <br /> ,, ths butlding permit owner on nodce of thts assessment and thQ conditlons of payment for same. <br /> DATE RECENED BY <br /> RECEIPT NO. DATE BY <br /> I <br />