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PASCO COUNTY, FLORIDA <br /> Permit No. <br /> Date Permitted <br /> Builder Name/Owner Name 4r Control#' <br /> County Parcel No. (� SubDiv: <br /> (; Address/Location J� 2, / 6Vt'�` braky <br /> Classificatlon/Type of Use �S �p �,r•,,1!�i <br /> i� <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: ��17 <br /> Exempt []Yes ❑ No How Determined <br /> Impact Fee Amount $. 3, Z Cb Zone No. TAZ: <br /> SCHOOL IMPACT FEE C�q <br /> Account (056) Single-Family Detached House Amount $ <br /> (057) Mobile Home <br /> (058) Other Residential <br /> 123) Collection Fee <br /> Exempt [] Yes Q 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 $ <br /> Exempt ❑Yes ❑ No How Determined <br /> LIBRARY FEE <br /> Land Account Land Credit Land Total <br /> i. <br /> Facility Account Facility Credit Facility Total <br /> Exempt ❑ Yes ❑ No How Determined Total Amount <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT <br /> Prepared By 4 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 /> i <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />