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:d/ Y <br /> �W. <br /> i4rY <br /> 'PASCO COUNTY, FLORIDA <br /> V <br /> Permit No. <br /> / Date Permitted el� <br /> 'Builder Name/Owner Name �l L Control#' " <br /> County Parcel No. SubDiv: } � <br /> �3f-- <br /> AddresslLocatlon 96 7 Ciassifloationrrype of Us@ c5 le <br /> TRANSPORTATION IMPACT FEE ' Rate: S4-Ft Unit: <br /> Exempt Q Yes [3 No Now Determined <br /> Impact Fee Amount 4 Zone No. TAZ: <br /> SCHOOL IMPACT FEE <br /> Account (O58) Single-Family Detached House Amount $ <br /> (057) Mobile.Home <br /> 1 (058) Other Residential <br /> 123) Collection Fee <br /> Exempt (�Yes . Q No How Determined <br /> PARKS AND,RECREATION FEE <br /> Land Ad6bunt Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation Total <br /> Zone TOTAL AMOUNT $ 7& , <br /> Exempt ❑Yes ❑No How Determined <br /> LIBRARY FEE `M <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 UNTIL THE TOTAL AMOUNTS LtSTED'HAVE <br /> BEEN PAID',AND <br /> RECEIPTED FOR 13Y A CENTRAL'PERM ftNO OFFICE-OF PASCO COUNTY <br /> Acknoydedgement below does nothnply acceptance of concurrence,but simply receipt of a copy of this form,placing <br /> the building permlt owns-on notice of this assesarnent and the condWons of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />