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i <br /> s <br /> i <br /> ' PASCO COUNTY, FLORWA <br /> Date•� •i•, '�` Data PeOnllted <br /> I / <br /> Builder NemelOwner Name &/w� /&6 Control#' <br /> f !y <br /> CountyPefi:elNo. Zl� 21—bile—dLl z(o�SubDIV: �- <br /> I Address/Locadon 3 qZ A14, rn � <br /> f Classificallon/Type of Usq <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: 2f 3 72 i <br /> Exempt ❑Yes ❑No How Determined <br /> ' Impact Fee Amountjo 3 Zone No. TAZ: j <br /> SCHOOLIMPACTFEE <br /> Account (056y Single-Family Detached House Amount $ <br /> (067) Mobile Home <br /> (055) Other Residential <br /> 123) Collection Fee <br /> Exempt Yes ❑No How Determined <br /> PARKS AND RECREATION FEE <br /> Land Accotint Land Credit Land Total <br /> j Recreation Account Recreation Credit ;Recreation Total u <br /> Zone TOTAL AMOUNT S '76956 <br /> • I <br /> Exempt Q Yes ❑No How Determined <br /> LIBRARY FEE <br /> Land Account Land Credit Land Total j <br /> Factilty.Account Facility Credit Facility Total <br /> Exempt ❑Yes ❑No How Determined Total Amount-�- I <br /> i <br /> RESOURCE FEE ERU <br /> TOTALAMOUNT <br /> Prepared By Chocked By <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTIL THE TOTAL AM04NTS LISTED HAVE <br /> BEEN PAID AND. <br /> RECEIPTED FOR BY A CENTRAL PERMIIIMNO OFFICBOF PASCO COUNTY <br /> Acknowtadgemont below does not Imply acceptance of concurrence.but almply recelpt ofa cow of we form,placing <br /> the buWngi permit owner on notice of dill nesesament and fhe omdltlom of payment far same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />