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,„. <br /> � �l�1.�M� ���1V Y�y ���I'6�6�� <br /> �,.� Permit No. � �( <br /> Date Permltted `�� <br /> i Bulider Name(Owner Name �� R�f Cantroi# <br /> County Parcei No. ���-2(-� �aZO--C��O-D tSt� SubDiv: c�i U� <br /> ��, , AddresslLocatian �ii�35 ?��� K�'C��f <br /> ° - CtassificatlonlType of Use cS c , � • <br /> Yr . <br /> ���f3, TRA�dS�ORTATION iMPACT F�E Rate: Sq.Ft Unft: �� Z�S <br /> k"f< <br /> `A� Exempt []Yes �] IVa Hou,r Determtned <br /> i;•• <br /> i-. � tmpact Fee Amount � -.�2' 2 ` 2one No. TAZ: <br /> ri"`' SGNOOL IMpAGT FEE <br /> ';°'� Account (056� SingVe-Famtly Detached House Amount $ �8��j.� <br /> (057} Mobile Home <br /> (058) Other Restdentiat <br /> 'w� 123) Gallectlon Fee <br /> � ' Exempt �Yes a No How Determined <br /> I � , �ARKS A{dD RECREA710N PEE <br /> , Land Account Land Credit Land Tota! <br /> Recreation Account Recreation Credit �Recreatfon Totai <br /> Zone TOTAL AMOUNT $ t b (`�� <br /> � Exempt ❑Yes [] No How petermined <br /> - L18RAR.Y FEE <br /> ���,,. Land Account Land Credit Land Total <br /> S� <br /> � Facitity Accaunt Faci!!ty Credit Factlity Tatat <br /> �;:: <br /> Exempt ❑Yes ❑ No How Qetermined Total i4moun��_ <br /> i`` ^ <br /> �� RESOURCE FEE ERU <br /> TOTAL AMOUNT `7 � <br /> Prepared By � Checked By <br /> NO CERTIF{CATE OP t�CCUPAMCY WILL BE ISSUED OR FINAL INSPECTION <br /> ` PERFORMED UN1'IL 7HE TOTAL AMOUNTS�ISTED HAVE <br /> � BEEN PAiD AND <br /> RECEIPTED FOR BY 1�►C�NTRAL PERM1'T'ftNt3 OFFlCE OF PASCO COUtdTY, <br /> :� <br /> � Acknowledgemant belaw doea not Impiy aeceptance of ooncurrsncs,but stmpty receipt of a copy of thls form,ptacing <br /> %f. the bufiding permlt awner on noUce of this assessment and tha condittons of payment for same. <br /> i.: <br /> � <br /> �, <br /> DATE . RECEIVED BY <br /> RECEIPT NO. DATE BY <br /> � ,rt_ __.. � <br /> ��,��� — a.- ______________ <br /> ��;.��- <br />