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PASCO C:OUNTY9 FLORIDA <br /> AzPermit No. <br /> Date Permitted <br /> 'Builder Name/Owner Name l Ste- Control#' <br /> County Parcel No. Zf 61/e0- SubDly: <br /> Address/Locatlon <br /> " c <br /> Classification/Type of Usq <br /> I TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: <br /> Exempt' M Yes •[]No How Determined <br /> Impact Fee Amount $.'4 -__-- Zone No. TAZ: <br /> r . <br /> SCHOOL:IMPACT FEE <br /> Account (056) Slh&wFamlly Detached House Amount $ Z <br /> (ov) Mollie home <br /> (058) OtherResldentlal <br /> d23) <br /> Collection Fee <br /> Exempt Yes . Q No How Determined <br /> PARKS AND-RECREATION TEE- <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation Total <br /> Zone TOTAL AMOUNT <br /> Exempt [Q 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 Amour .! <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT <br /> Prepared By t Checked By <br /> NO CERTIFICATE OF OCCUPANCY WILL 13E ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTIL THE:TOTAL AMOI.JNTS 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 ieceipS of a ropg of this form,placing <br /> the building permit owner.on nodes of this assessment and the condhions of payment forsame. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />