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PASCO COUNTY, FLORIDA <br /> ( _ Permit No. <br /> Date Permitted KE_2 ?-,a <br /> i Builder Name/Owner Name d Control#' " <br /> r County Parcel No. �3�-Z vr-Z/--6lb-D�br�jrL134�o SubDiv: 1°� <br /> r �/� <br /> Address/Location �3 z- 1"(Jr <br /> GlassiflcatlonlType of Use (d P l <br /> TRANSPORTATION IMPACT FEE , Rate: Sq.Ft Unit: z 77 <br /> Exempt ❑Yes ❑ No How Determined <br /> { Impact Fee Amount $. a tP3,7 Zone No. TAZ: <br /> l <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $ , <br /> (057) Mobile Home <br /> i (058) Other Residential <br /> 123) Collection Fee <br /> 1 Exempt �Yes []No How Determined <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation Total <br /> Zone TOTAL AMOUNT <br /> Exempt []Yes ❑ No How Determined <br /> LIBRARY FEE <br /> Land Account Land Credit Land Total <br /> Facility Account Facility Credit Facility Total <br /> Exempt ❑ Yes ❑ No Haw Determined Total Amount <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT <br /> Prepared By ` Checked By <br /> NO CERTIFICATE OF.00CUPANCY 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 /> Acknowledgement below does not Imply acceptance of concurrence,but simply recelpt of a copy of this form,placing <br /> the building permit owner on notice of ails assessment and the conditions of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />