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_-�--r-----�, <br /> �,.,,.t--��.--- - <br /> �....,......�--ne---- _ _� <br /> .� <br /> : ��4SC� ��4�6��"�, �LORID� <br /> "_ F'ermlt tVo. ���_, <br /> Date Permitte �� �'-+€� <br /> ^Builder Name/Owner IVams �'�-��GG�►�" `6+Ow1�E� Control# <br /> ' County Parcel No. 2'�-2�0�Z�-b��0-b0l��}�)3�0._ SubDiv: ►�'�`�`� �w� <br /> AddresstLocation �.1`�7 1iv��u,�(�i�vl i-t�Wa� ��- <br /> �. ( ���.r� <br /> � CtassiflcatioM'ype of Use �;rXx !j?_ LG <br /> 'Y_., ---�---� --�- <br /> �= TRAR4SPORTATiON IMPACT FEE Rate: Sq.Ft Unit: �5 <br /> i : <br /> Exempt []Yes [] No Mow Determined <br /> c� <br /> �':.:. ' lmpact Fee Amaunt $. �,�o�J2� Vb Zbne No. TAZ: <br /> '�:= SCHOOL iMPA►C'C FEE 1`�, / <br /> ' Accaunt (056)' Sing►e-Family Detached htause Amount $ `tD 14��Z� <br /> '�`' (057} Mabtle Ftome <br /> (058} Other Residentlal <br /> 123) Caitectian Pee <br /> . Exempt []Yes Q No How Determtned . <br /> PARKS AND RECREAT{ON FEE <br /> Land Account Land Credtt Land Total - <br /> Reoreation Accaunt Recrea#ion Credlt Recreation Total <br /> Zone TOTA�AMOUNT $ ��•� <br /> Exempt �Yes ❑ No Haw Determtned <br /> � L{BRARY FEB <br /> Land Accaunt Land Credit Land Totai <br /> Facility Rccount Facillty Credit �aoifity Totai <br /> � Exempt � Yes ❑ No How Determined Tutal Amour►t��� <br /> � <br /> RESOtfRGE FEE ERU <br /> T07AL AMOUNT � <br /> Prepared By � Checked By <br /> NO CERTtFiCATE OF OCCUPANCY WtLL BE tSStlED OR�fNAL INSP£GTiON <br /> P�RFORMED UNTIL TNE TOTAL AMOUNTS LISTED HAVE <br /> BEEN PA1D AND <br /> RECEIPTED FOR BY A CENTRAL PERMtTi'iNG OFFtCB OF PASCO COU4ITY <br /> Acknowiedgement betow doea not Imply acceptance of concurrence,but sfmpiy reoeipt of a copy of thls form,piacing <br /> [he buflding permit owner on nofice of th)s assessment and thQ condiUons of payment tor same. <br /> RATE RECEIVED BY '� <br /> � <br /> RECEiPT Nd. DATE BY �� <br />