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PASCQ-COUNTY, FLORIDA <br /> Permit No, <br /> Date Permitted 2—t —(9 <br /> Builder Name/Owner Name t�.�._l.Cn1 Control#' <br /> County Parcel No. j�tQ —Q[���` C� SubDiv: `T`ts�1 a <br /> a;. <br /> Address/Location 3 7 `i'Y��c�Y1 2 Y <br /> Classification/Type of Use <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: <br /> Exempt Yes [] No How Determined <br /> Impact Fee Amount $.�,�p,�^ <br /> Zone No. TAZ: <br /> 2-" <br /> SCHOOL IMPACT FEE <br /> f' Account (056) Single-Family Detached House Amount $ <br /> (057) Mobile Home <br /> (058) Other Residential <br /> 123) Collection Fee <br /> Exempt []Yes ❑No How Determined <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit �Recreatton Total <br /> Zone TOTAL AMOUNT $ cl4cSgj <br /> Exempt [j Yes No Haw Determined <br /> LIBRARY FEE <br /> Land Account Land Credit Land Total <br /> Facility Account Facility Credit Facility Total <br /> Exempt ❑Yes ❑ No How Determined Total Amours - �f <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT <br /> Prepared By Checked By <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION_ <br /> PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE.OF PASCO COUNTY <br /> Acknowledgement below does not Imply acceptance of concurrence,but simply receipt of a copy of this form,placing <br /> the building permit owner on notice of this assessment and the conditions of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />