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r <br /> r <br /> ' PASC®C®UNTI(, FLORIDA <br /> ti Date POEM t Itted z - <br /> fJ2 <br /> Bulkier NemelOwner Name / p �Con�trol vY' _ /� <br /> I <br /> County Parcel No., 'ZJ`-Z�- 1`(D-�U ILYJ'd75Gb�(v: 7 P F°` 6 <br /> Addressfl.Mdan 7917 i e <br /> Cfass111cation/Type of Usq <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unle 3 / <br /> i Exempt ❑Yes ❑No How Determined <br /> 4 ; Impact Fee Amount S 3, 6 32, Zone No. TAZ j <br /> I <br /> j SCHOOL IMPACT FEE <br /> Account (058) Single-Family Detached House Amount <br /> (067) Mobile Home <br /> (055) Other Residential <br /> 23) Collection Fee r' <br /> Exempt a Yes ❑No How Determined <br /> PARKS AND RECREATION FEE t <br /> Land Account Land Credit Land Total <br /> ! Recreetlon Account Recreation Credit :Recreation Total <br /> Zone TOTAL AMOUNT R]6?S,6 <br /> • I <br /> Exempt ❑Yes ❑No How Determined <br /> LIBRARY FEE <br /> Land Account Land Credit Land Total j <br /> Faclllty.Acoount Facility Credit FacllityTOW <br /> Exempt ❑Yes ❑No How Determined Total Amount_ I <br /> RESOURCEFEE , ERU <br /> TOTALAMOUNT <br /> Prepared By U 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 /> Aoxnowtoegementbalpw deco not Imply sasptar-of eonour epccbut Aw*reeelptofa copy of this form,placing <br /> the bulldinp P, own'an intioe of thM asseaemant aril tho wrtmoom of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />