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� <br /> ` � ; �As��� ������� '�����'��� <br /> ' _ Permtt No. ,� .3 <br /> ' Date Ferm(tted 2 Z.t� <br /> Builder NamelOwner Nama� I )� '�"�(J���� Control# <br /> County Parce4 No. Q�2(e-2 t-OU�(�-C�7Ob-r.�Cl> SubDiv: �� e.z��_ <br /> AddrasstLocation �P��2. rk. � <br /> ,�=�- Classi�cationiType of Use V r 1 <br /> �>.' - <br /> f�",- TRANSPORTATtON IMPACT FEE Rate: Sq.Ft Untt: Z�,2 3�y <br /> ,<� <br /> �`;;. Exempt [�Yes [] No Haw Determined <br /> � Impact Fee Amount $. 3, �32� Zone No. TAZ: <br /> ;��s:� <br /> �"-� SGHOOL iMPA6T FEE <br /> �`=_: <br /> Account (056) Single-Family Detachad House Amount $ ��3 2�• Zt�3 <br /> �Y,..;, (057) Moblte Wame <br /> (Q58} Other Resldenttal <br /> - 123) Coltection Fee <br /> Exempt (�Yes ❑No Mow Determined <br /> PARKS AND REGREAT{ON FEE <br /> Land Account Land Credtt Land Tatai <br /> Recreation Account Recreation Credlt Recreation Total <br /> Zone TOTP,L AMOUNT $��,�- ��, <br /> � Exempt �Yes ❑ No How Determined <br /> - LtBRARY FEE <br /> a�` Land Account Land Credit Land Total <br /> Faclfity Account Faciifty Credit Faciitty Totat <br /> ` Exempt �Yes ❑ No How Determined Totai Am ��� <br /> RESOURCE FE£ ERU <br /> TOTAL AMOUNT � <br /> Prepared By Checked By <br /> NO CERTIFICATE OF OCCUPANGY WILL BE ISSUEQ OR FiNAL INSPECTlON <br /> � PERFORMED UNTlL THE TOTAL AMOUNTS US'['ED NAVE <br /> � BEEN PA{D APlD <br /> RECEIPT�D FOR BY A CENTRAL PERMITTtNC3(?�FICE OF PASCO COUNl`1P <br /> Acknowiedgement belaw does not imply accaptance of concurrence,6ut sirnply recelpt of a copy of this form,placing <br /> �, the bufiding permit owner on naBce of this assessment and th�condfUons of payment for same. <br /> -` DATE RECEIVED BY � <br /> RECEIPT NO. DATE BY i <br /> i <br /> _ ___________ __. I <br /> ,�..:,�:<«r_�z._ ::�.�:,-,---_:-��,,,-_ .�.. -_ { <br /> �r ��.: <br />