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w__ _ - _ _-_-- -- - - - - -- -- _ - <br /> z: <br /> " ` ��+��� ������y �L����� <br /> ! <br /> „"' � Permit No. ���� <br /> Date Permitted <br /> � Bullder NametOwner Name L P�l,t'�tk.�' �t;�3Y�.���...� Cont�oi# <br /> r _ �/ <br /> County Parcel No. Q`y-2.-(e_'�,�_f�'Zp---jj��..b��pSubDiv; �� {,'�axcl.%(.� <br /> Address/Lpcation Gi�2 v'� 21l i/� �' <br /> . <br /> ClassificatfonlType of Use � <br /> �'� ' TRANSPORTl0.'CtOtV IMPACT FEE Rate: Sq.Ft Un1t: ��2,�� <br /> t,. <br /> '� Exempt []Yas [] No Houv Determined <br /> �� � Impact Fae Amount $.�t�3��� Zons Na. TAZ: <br /> i,=;, SCHOOI.iMPAGT PEE t£ <br /> Account (056) Single-Family Detachsd tiouse Amount $ C���� <br /> i'�' (057) Mobi{e Homa <br /> { {058) C?ther Resldentfal <br /> 123} Goilection Fee <br /> Exempt �Yes []No How Determ(ned <br /> • PARKS At�D RECR�ATtON FEE <br /> Land Account Land Credit Land Tota! <br /> � Recreation Account Recreaklon Credit �Racreation Total <br /> Zone T�TAL AMOUNT $ '���-c'S�', <br /> ' Exempt ❑Yes [] No How Qetermined <br /> - LIBRARY FEE <br /> , Land Account Land Gredit Land Tota( <br /> � � Facility Account Facility Cradit Facitfty Total <br /> �� <br /> �' Exempt [�Yas ❑ No How Qetermined Tatai Amour`�iE'� <br /> ti <br /> RE80URCE FEE ERU <br /> TOTAI.AMOUNT '-> <br /> � <br /> � " <br /> Prepared By � _ Checked 6y <br /> NO CEFtTIF{CATE OF OCCUP'ANGY WILL 8E 15SUED OR FINAL INSPECTION <br /> - PERFORMEp UNTtL 7HE TOTAL AMOUNTS i,lSTED HAVE <br /> BE�N PAID AtdD � <br /> RECEiPTED�OR BY A C@{�TR/AL PERMITTltdt3 OFFICE OF PASCB COURI7Y i <br /> � Aoknowiadgemant betow does not impiy acceptanca of concurrence,but simply raceipt of a capy of this form,ptacing <br /> the building permit owner an notice of this assessment and tha conditions of payment for seme. <br /> �' <br /> RATE RECEfVED BY <br /> � RECEIPT NQ. DATE BY <br />