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t r <br /> Pr%QC® COUNTY, FLORIDA <br /> Permit No. <br /> Date Permitted <br /> Builder Name/Owner Name ry r t Control#' <br /> County ParClel No. b (00--�O�9 lgg dubDiv: J f <br /> Address/Location S Y`�r AID <br /> ClassificationlType of Use cgt e_ <br /> `l <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: Zw3�3 <br /> Exempt n Yes [] No How Determined <br /> Impact Fee Amount $. J4 J Zone No. TAZ: <br /> j I SCHOOL IMPACT FEE _ <br /> ( Account (056) Single•Famiiy Detached House Amount $ <br /> (057) Mobile Home <br /> (058) Other Residential <br /> 123) Collection Fee <br /> Exempt n Yes [] No How Determined <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation Total ��rr <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 Amod <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,OFPASCO 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 some, <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />