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' PASCO COUNTY, FLORIDA <br /> ' * Permit No. <br /> Date Permitted _ <br /> Builder Name/Owner Name its / Control#' <br /> County Parcel No. ��" "D 0"00 0 2-0 00 SubDiv; c]. tM <br /> Address/Location l O- )a -Kh <br /> Classiftcation(Type of Usq 3; r [C4 <br /> 22 <br /> TRANSPORTATION IMPACT FEE • Rate: Sq.Ft Unit: 13-) tv <br /> Exempt []Yes ❑No How Determined <br /> impact Fee Amount : 3.t/!062• Zone No. TAZ; <br /> SCHOOL IMPACT FEE <br /> Account (055) Single-Family Detached House Amount $ <br /> (057) Mobiia:Home <br /> (058) Other Residential <br /> 23) Collection-feeExempt 6 Yes n No How Determined <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation Total. <br /> Zone TOTAL AMOUNT $76f--,6fo. <br /> Exempt ❑Yes ❑No How Determined <br /> LIBRARY FEE <br /> Land Accounf Land Credit Land Total. <br /> Facility Account Facility Credit Faculty Total <br /> Exempt ❑Yes ❑No How Determined Total Atnounl q!' — <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-knpiy acceptance of concurrence,but simply racetpt of•a copy of this form,placing <br /> the building permit owner on notice of this assessment and 1he-condttions of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />