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PA CO COUNTY, FLORIDA <br /> •P�l►it No. zz�53 <br /> tit Date PeOnitte <br /> I • 6 <br /> Builder Name/Owner Name Control q' <br /> County Papal No. 3 ubDiv: <br /> i <br /> AddresslLocation S &qad <br /> ClasslflcatioNrype of Usti yl I <br /> t TRANSPORTATION imer FEE Rate: Sq.Ft UNt: I <br /> Exempt ❑Yes ❑No How Determined <br /> j� Impact Fee Amount <br /> &32•0 Zone No. TAZ: <br /> SCHOOL IMPACT-FEE <br /> Account (05e) Single-F 3mlly,06tached House Amount $ U� <br /> (067) Mobile Home. <br /> (OSB) Other identlal <br /> +I 123) Collect) n Fee ;. <br /> ! Exempt d-Yee ❑No How Determined <br /> !.! PARKS AN67:RECREATIO FEE I <br /> Land Account Lend Credit Land Total <br /> + Recreation Account Recreatlon Credit •Recreatlon Total i <br /> Zone TOTAL AMOUNT 7k k y <br /> • I <br /> Exempt 0 Yes ❑Nc How Determined <br /> LIBRARY-FEE <br /> Land Account Land Credit Land Total i <br /> Fac llty.Acoount Facility Credit Faduty Total <br /> Exempt []Yes (3No How Determined Total Amount <br /> RESOURCE FEE , ERU <br /> TOTAL AMOUNT <br /> Prepared By Checked By <br /> NO CERTIFICATE DF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION <br /> PERFO ED UNTIL THE TOTAL AMOUNTS LIMD HAVE <br /> BEEN PAID:AND.' <br /> RECEIPTED FOR By A CENTRAL PERMI7TINd OFFICE•OF PASCO COUNTY <br /> AoxnorMdpwnont below d000 of lmpty,acooptena of eoncurrenoo,but Wnpty reoelpt ofa coW of We form,ptactnp <br /> the bulft pw t o er on eoba of Ws weeoaaent and tie wnditonf of payment for Mo. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />