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r' PASCO COUNTY, FLORIDA <br /> Permit No. �� <br /> Date Permitted =� d <br /> Builder Name/Owner Name A>mei Control#' <br /> County Parcel No. ?� 2 ro Z/•D//�!�'�/al�$o SubDiv: <br /> Address/Locatlon � <br /> Classification/Type of Usq <br /> TRANSPORTATION IMPACT FEE . Rate: Sq.Ft Unit: .37Z <br /> Exempt ❑Yes -[] No How Determined <br /> Impact Fee Amount $: Ma cc��2 Zone No. TAZ: <br /> SCHOOL IMPACT FEE_ / <br /> Account (058) Singie-Family Detached House Amount $ <br /> (057) Mobile Home <br /> s (058) tither Residential <br /> 123) Collection Fee <br /> 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 $ 7trtlr c�� <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 How Determined Total Amount <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT <br /> Prepared By Checked By <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTn.THE TOTAL AMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMOTINO OFFICE.OF PASCO COUNTY <br /> Acknowledgement below.does not Imply acceptance of concurrence,but simply receipt of•a copy of this form,.placing the building permit owner,on notice of this assessment and the conditions of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />