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a <br /> V ASCO COUNTY, FLORIDA <br /> - - Permit No. <br /> Date Permitted' o <br /> Builder Name/Owner Name zv r- Control <br /> County Parcel No. subDiv: <br /> ` Address/Locatlon <br /> I �r <br /> r <br /> Classification/Type of Use <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: <br /> Exempt ❑Yes ❑ No How Determined <br /> Impact Fee Amount Zone No. TAZ: <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $ <br /> (057) Mobile Home <br /> (058) Other 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 $ <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 ISSUEiD 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 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 />