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f i <br /> I <br /> i <br /> PASCO COUNTY, FLORIDA <br /> 3 t\ f Dattee Papnitted <br /> I i Builder Name/Owner Name Control W <br /> County Parcel Na.j_ _ U(tlQ-CY�ODa. �r SubDiv: <br /> ' Address/Locadon 3 ` �- <br /> Classif callonfType of usq <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: z4My— <br /> i. <br /> Exempt ❑Yes ONO How Determined <br /> Impact Fee Amount $,3/ Zone No. TAZ: <br /> a <br /> SCHOOL IMPACT FEE -( e t <br /> Account (058) Single-Famlty Detached House Amount $� /'J(J c <br /> (457) Mobile Home <br /> (058) Other Residential <br /> 123) Collection Fee ,;• <br /> Exempt (�Yes ❑No How Determined <br /> PARKS AND RECREATION FEE i <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit :Recreation Total <br /> Zone TOTAL AMOUNT s <br /> Exempt ❑Yes ❑No How Determined <br /> LIBRARY FEE <br /> Land Account Land Credit Land Total � <br /> Facllity.Accdunt Facility Credit Facility Total <br /> Exempt ❑Yes ❑No How Determined Total Amount L�- I <br /> RESOURCEFEE 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 /> RECEIPTEO FOR BY A CENTRAL PERMITTING OFFICEOF PASCO COUNTY <br /> Admwtedgement below does not Imply acceptance or concurrence,but aimpty receipt of®copy of this form,placing <br /> the bonding parmitowner on no@ce of ft assesamen►and the condidons of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />