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RASCO COUNTY, FLORIDA <br /> Permit No. <br /> (� Date Permitted ,- <br /> Builder Name/Owner Name 1) K �"T_ Control#' <br /> County Par4el No. p 5 Z��Z(-bQZ .-© -bl�l o Subaiu: D 0 <br /> Address/Location <br /> Classification/Type of Use ino le <br /> i TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: 2 T 53 <br /> i <br /> t <br /> i Exempt ❑Yes [} No How Determined <br /> 4 <br /> 4 Impact Fee Amount $. 31 (0 3 2 Zone No. TAZ: <br /> SCHOOL IMPACT FEE ^1t <br /> f Account (056) Single-Family Detached House Amount $ !/ �- <br /> (057) Mobile Home <br /> (058) 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 /> Recreation Account Recreation Credit Recreation Total <br /> Zone TOTAL AMOUNT $ p� <br /> Exempt []Yes [] No How Determined <br /> LIBRARY FEE <br /> Land Account Land Credit Land Total <br /> Facility Account Facility Credit Facility Total <br /> — <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 thq conditions of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />