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� ' �: 1�ASG� ����TY, �LOR��� <br /> _. -` .`. ,. Permlt No. �� <br /> : -" Date Permitted /%34--(�5 <br /> Builder Name/Owner Nams �.,@,r/�.viC,r �i�lYK.�S' Controi# <br /> County Parcel No. �5-26-Zt-0o?O-�x�o--d0`�C� SubDiv: cS� �tl���j <br /> �;'. _, AddresslLocatlon �� Z� c.�i �U��D +�-�� �i �� <br /> �°: Classiflcatlonti'ype of Use cS��d1cf �� `�-��`t,� .. <br /> 1�..:` TRANSPORTATIC?N IMPACT FEE Rate: Sq.Ft Unit: ���____ <br /> �, <br /> � Exempt []Yes [j No Houv Determined <br /> `�� ' Impact Fee Amount $.t���j 2'�) Zone No. TAZ: <br /> ;,:- <br /> r.;, <br /> �' SCHOdt,IMPAGT FEE <br /> ;,:= <br /> Account (456) Singis-Famfly Detached House Amount $ '��j 7�v-ZZ�J <br /> �' (057) Moblle Home <br /> �=� {�58) Other Residentiai <br /> 4, <br /> �= 123) Goilectlon Fee <br /> Exempt []Yas ❑No Haw DetermIned <br /> " ` RARKS/�NL�RECREATION FEE <br /> _. Land Account Land Credit Land Total <br /> Recreation Account Recreatian Credit �Recreatian Totai <br /> Zone TQTAL AMOUNT $ ����-cS�v <br /> ' Exempt [�Yes [] No How Datermined <br /> r ' <br /> LtBRARY FEE <br /> � Land Account Land Credit land Total <br /> ?y� Fac(lity Account Facility Credit Facifity Total <br /> '>`` ' Exempt [�Yes ❑ No How Determined 7otal Amountr�`-"" ^ <br /> Y,- <br /> 1 <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNl" � <br /> Prepared By Checked By <br /> � MO C�RTlF{CATE OF GICCUPANGY WtLL BE ISSUER OR FINAL tiVSPECTION <br /> � PERPORMED UNTiL THE TOTAL AMOUNTS LISTED HAVE <br /> � BEEtV PAID AND <br /> : � <br /> REGEIPTED FOR BY A CENTRAL PERM!'I"PINQr t)FFICE OF PASCO COUPt'iY <br /> � Acknowiedgement below does not impiy acceptance of concurranca,but simp{y receipt of�a copy of this form,placing <br /> the buflding permit owner on noUce af this assessmant and thQ cond{Uons af paymant for same. <br /> DATE RECEtVED BY - <br /> RECElPT NO. DATE BY <br /> �_� y� �., .._�.� ..��--�.� <br /> -�---_•_-. __--_---____ <br />