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sy4. <br /> . � : ��4S�+p �PJtJNT'Y9 �'�C�RID�4 <br /> � <br /> .h �R 3a� <br /> Permtt IVo. <br /> Date Perml�ted 2-k�1 Y3 <br /> ' Builder NamelOwner Name ���G� 't'tOw+,'e-� u�' Controt# <br /> CountyParcelNo. `��"'"�`�"'���"����•a�'�ubDiv; },�-u2�.�1 �t�A¢r� <br /> AddressiLocation c'���'� l'���(�iP,r� '��at,t� �,2. <br /> �, + i � <br /> Classificatfon(!'ype of Use S,a`Y�q, �p `i�mc 1 t� <br /> `s ., <br /> >;: TRA�ISPORTATIDN IMPACT FEE Rate: Sq.Ft Uni� . 2-,3�� I <br /> 7? <br /> �;5= <br /> z,,,' Exempt [�Yes [�No How Determined <br /> ;r, <br /> i;s:_ . � I <br /> �,� (mpact Fee Amount �. �i�ra v 2-� � Zone No. TAZ: , <br /> t.. <br /> ;�;_ <br /> �° SCHdOL iMPAGT FE� ,�, <br /> E'.�, <br /> Account {056} Single-Family Detached Housa Amaunt $ ��p- Z- <br /> `���, {057) Mobite Hame <br /> (058j Other Residential <br /> � , 123) Gollectfan Pee <br /> Exempt [�Yss �No How Determined <br /> PARKS AND REGREATION FEE <br /> Land Account Land Credit Land Total <br /> � Recreatian Account Recreation Credit �Recreatfon Totai <br /> i Zone TOTAL AMt?UNT $�(� `��S� <br /> � Exampt ❑Yes ❑ No kiow Detecmined <br /> � . <br /> � LtBRARY FEE <br /> Land Rccount Land Credit Land Tptal <br /> , Facility Account Facility Cred{t FacllEty Total <br /> ' ' Exempt ❑Yes ❑ No Haw Determined Total Amour�_'�_, <br /> � <br /> RESQURCE FEE ERU <br /> TOTAL AMOUN7 � <br /> Preparetl By � Checked By <br /> ', NO CERTIFtCATE(DF CICCUPANGY WILi.BE ISSUED OR PINAL INSPECTION <br /> I � PERFCJRMED UNTIL THE TOTAL.AMC?UN73 LISTED HAVE <br /> '� ' BEEN RAID AND <br /> IRECEIPTED FOt�BY A CENTRAL PERMITTtNG OFElCE�OF PASCO COUNTY <br /> Acknowiedgemant below does nat Imply accaptance of concurcencs,6ut slmpty receipt af a copy of thts form,placing <br /> � the building permit owner on notice of thts assessment and tha condiUans of payment tor same. <br /> , �, <br /> • dATE REGEIVED BY <br /> RECEIPT NQ. DATE BY <br /> I __ _________-- - <br />