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' .`' li""���r� ������s ��.�d�"at1�� <br /> • r <br /> �.'� ! Permtt No. � � <br /> Date Permitte �.- !!•�_. <br /> � 6uilder Name/0wner Name W[�1,YtQ� �za�`�`� Controi# <br /> County Parcel No. d 5"�'�-'�Q�o-a o 3av-�D4(v L7 SubDiv: c:�� jJP��,�� <br /> _ AddresslLocation � �� ��P..tR � � <br /> ! �Ctassit1caflonlType of Use � <br /> ,tt: <br /> � TRANSPOR'TATION I�flPACT FEE Rate: Sq.Ft Unit: _.�,�_ <br /> a= <br /> Exempt []Yes � No Ho�r betermined <br /> r'` � � �.�� <br /> ;.. <br /> impact Fee Amount $. � Zone No. TAZ: <br /> ``� SCNOOL IMPAGT FEE <br /> Account {056� Singia-Family Qe#ached tiouse Arnount $ _ ��Z{,�,��� <br /> �'� (057} MobHe Home <br /> � (058) Cfther Resfdentlai <br /> � 128} Co{lection Fee <br /> �xempt [�Yes ❑No How Determ(ned <br /> ' PARKS AND RECR�ATIOM FEE <br /> l.and Account Land Credlt Land Total <br /> Recreation Account Recreation Credlt �Recreatton Total <br /> Zona T(3TA�AN{OUNT $ �I�a�~`��° <br /> Exempt [�Yes [] Na Haw Determined <br /> LlBRAR.Y F�E <br /> � <br /> Land AccounE Land Credit Land Total <br /> 'F:� <br /> �= Facility Account Facilily Credit Faci{ity Totai <br /> ;� <br /> Exempt ❑Yes ❑ No How Determined Tota{Amount�-_ '�'�^ <br /> - RESOURCE FEE ERU <br /> � 70TAL AMOLlNT '-, � <br /> � <br /> Prepared By Checked By <br /> NO CERTIFtCATE OF OCCUPARfCY WIl.L BE ISSUED OR FIHAL INSPECTIOIV <br /> `� PERF�RMED UNTlL THE TOTAL AMOUNTS lISTED HAVE <br /> ` B�EN PAfD AND <br /> RECElPTED FOR BY A CENTRAL PERMITTINIG fiFElCE-(!F PA5G0 COUN'1'Y <br /> ' Acknowiedgement below does not impiy acceptance of aoncurrencs,but stmply recelpt of a copy of thts form,placing <br /> tha buiiding permit owner on notice of this assessment and thQ condKions of payment for same. <br /> , <br /> • DATE RECE{VED BY <br /> RECEIPT NO. DATE BY <br /> I _._ ,___...��..--a <br /> ; _,�,_�.,�r.�..�_._. <br />