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r i <br /> PASCO COUNTY, FLORIDA <br /> 4rot No. —Z A <br /> Date PeOwllted <br /> ? Builder Name/Owner Name �T`/PJI Control W.. <br /> ` <br /> County Pa{cel No. 3�f z-6-zt!0160-60000,3//Osu Dlv: 6! )td'1'r A <br /> • <br /> Address/Location 5Z / 2 A <br /> Classitlrationrrype of UsQ �r�(� i <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: < <br /> i Exempt ❑Yes ❑No How Determined <br /> Impact Fee Amount 3)437,160 Zone No. TAZ: i <br /> . I <br /> SCHOOL IMPACT FEE <br /> Account (066) Single•Famlly,Detached House Amount $ <br /> (067) Mobile Home <br /> (066) Other Residential <br /> 123) Collection Fee, <br /> i <br /> Exempt Yes ❑No How Determined P <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> ' Recreation Account Recreation Credit -Recreation Total <br /> Zone TOTAL AMOUNT $ 5-73. 73 N <br /> • I <br /> Exempt ❑Yes ❑No How Determined, <br /> LIBRARY FEE <br /> Land Account Land Credit Land Total j <br /> Faclllty.Acoount Facility Credit Facility Total <br /> Exempt ❑Yes ❑No How Determined Total Amount <br /> RESOURCE FEE , ERU <br /> TOTALAMOUNT <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 OFFICEOF PASCO COUNTY <br /> AcknovAedsoment below does not Imply accoplanee of concurrence,but ak"receipt of a copy of we form,piecing <br /> the bull ft pomilt owner on notice of thin asse6unent and the condiilone of payment for seine. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />