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PASCO COUNTY, FLORIDA <br /> Permit No. <br /> /�aa Date Permitted (Z <br /> Builder Name/Owner Name 4AeM (.d 5 Control#• <br /> County Parcel No. 4-2-f- o ^ �1,40 SubDiv: n7-� <br /> Address/Location 15-1 <br /> Classiflcatlonfrype of Use <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: <br /> Exempt ❑ Yes ❑ No How Determined <br /> Impact Fee Amount $. /6 67 Zone No. TAZ: <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $ ` <br /> (057) Mobile Home <br /> (058) Other Residential <br /> 23) Collection Fee <br /> Exempt a Yes Q No How Determined <br /> i 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 /> Facility,Account Facility Credit Facility Total <br /> Exempt ❑ Yes ❑ No How Determined Total Amount <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 />