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,y, I <br /> I <br /> � � ' �'A��G� ���3�1�'�, �L�t�ID� <br /> y �� Permit iVa. J 1 2'"�`� <br /> Dats Permitted � � <br /> Builder Name/Owner Name �`e-n-�-+�"��� Contral# <br /> Caunty Parce!No. 2-`�r Z�a�Z�^ �C��tQ--�L�^J(,(0 SubDiv: Ttt�dtn �%�+" <br /> , AddresslLocation �"� ( v�D Y vtdk,���., �-c(a� �i.J�. <br /> t <br /> +�� GlassificatlanfType of Use Ji�-W I�C. , L Ct ;. <br /> �`' 7RANSPORTATtON IMPACT FEE Rate: Sq.Ft Untr T�� <br /> i?" • <br /> �'`" � Exempt (�Yes [] Na Haw Determined <br /> ,,;. <br /> �'^ � Impact Fee Amount $. ��3�� Zone Na. TAZ: <br /> ,�'�� SCHOOL tMPAGT FEE r <br /> E`���� Accaunt (056) Singie-Famlly Detached House Amount $ ���so�2.g � <br /> ,., , <br /> Y�` {057j Mabtle Home <br /> ` , (058) Other Residential � <br /> rFi <br /> � 129) Collection Fee � <br /> Exempt [�]Yes []No Fiow Retermined� <br /> � � ' PARKS AND i�EGRSAT10td PEE <br /> Land Accaunt Land Credit Land Totat <br /> Recreatian Accaunt Recreation Cradit -Recreation Tatal <br /> Zone TOTAL AMDUNT $ "� �r_ � cS,b <br /> - Exempt Q Yes ❑ tVo How Determined <br /> LlBRARY FEE <br /> {�� Land Account Land Credit Land Tata! <br /> S�� <br /> it <br /> +' Faciiity Account Facilify Credlt Facility Totai' <br /> ,: <br /> F{ �. <br /> ; Exampt [}Yes ❑ No Haw Determined Total A►nount <br /> �_. <br /> RESOURCE FE� ERU <br /> TOTAL AMOUNT `� � <br /> � <br /> � <br /> Prepared By . Checked By <br /> NO CERTIFlCATE OF OCCUPANCY WtLL BE ISSUED OR FINAI.ItVSPECTtON <br /> -' PERFdRMED UNTIL THE 1'OTAL AMOUNTS LISTED NAVE <br /> : BEEN PAiD AND <br /> RECEIPTED Ft3�2 BY A CEN7RAL PERMITCING t3E�lCE OF PASCO COUN'CY <br /> ;s <br /> •� Acknowledgement below doea not tmpty aceeptance of concurrence,but stmply receipt of a copy of thls form,piacing <br /> ^ the buAding permlt owner on notice of ffits assessment and thQ canditions of paymant for same. <br /> i <br /> . �DATE RECEIVED BY <br /> ' RECEIPT NO. DATE BY <br />