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P <br /> Permit No. - - <br /> E Date Permlited <br /> `} ftW'C�JY1 # <br /> i Builder Name/Owner Name Control <br /> S _2kC= 0 t`� Subpiv: / <br /> county Parcel No. �S ZG� 7:t'I--���a <br /> I ' Address/Location �ye— <br /> Ciassiflcatlonlrype of Use �C <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: 2r c)l <br /> 1 =r' Exempt ❑Ves [1 No How Determined <br /> t • Impoct Fee Amount $. �0�J v Zone No. TAZ: <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $ <br /> (057) Mobile Home <br /> I (058) Other Residential <br /> 3Y3) Collection Fee <br /> Exemptes j I No How Determined <br /> t� PARKS AND RECREATION FEE- <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation Total <br /> Zone TOTAL AMOUNT $ 76 5yP <br /> Exempt ❑Yes ❑No How Determined <br /> LIBRARY FEE <br /> Land Accounf 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 �QtJ� Checked By <br /> NO CERTIFICATE OF OCCUPANCY 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 receipt of-a copy of this form,placing <br /> the building permit owner on notice of this essesement and the conditions of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />