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1PASCO COUNTY, FLORIDA <br /> Permit No. <br /> Date Permitted -1 <br /> Builder Name/Owner Name rlt2i "L Control#' <br /> County Parcel No. SubDiv: Lf `, <br /> Address/Location <br /> Classificationf ype of Use Siy{p 1G i <br /> TRANSPORTATION IMPACT FEE . Rate: Sq.Ft Unit: <br /> Exempt ❑Yes [] No How Determined <br /> Impact Fee Amount $. 3� s3� • Zone No. TAZ: <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $ Z ,[IF <br /> (057) Mobile Horne <br /> (056) 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 /> j <br /> Recreation Account Recreation Credit -Recreation Total <br /> Zone TOTAL AMOUNT $ 7fri��So <br /> Exempt ❑Yes ❑ No How 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 Amouns= j <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 I <br /> RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY <br /> i <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 />