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PASCO COUNTY, FLORIDA <br /> Permit No. c1J <br /> D to Permitted `j.-Z?y26 <br /> C_ <br /> Builder Name/Owner Name A <br /> County Parcel No, 2r'¢ - (�Z(¢a-ram- G SubDiv: <br /> Address/Location <br /> S & <br /> Classification/Type of Use 5 t�e t <br /> TRANSPORTATION IMPACT FEE ate: Sq.Ft Unit: ? <br /> Exempt ❑ Yes No How Determined <br /> Impact Fee Amount $3r � �' Zone No. TAM <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Famlly Detached House Amount $ � <br /> (057) Mobile Home <br /> (058) Other Residential <br /> 123) Collection Fee <br /> Exempt []Yes C1 No How Determined <br /> PARKS AND.RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation Total <br /> i Zone TOTAL AMOUNT $ - <br /> ` Exempt ❑Yes No How Determined- <br /> ` LIBRARY FEE <br /> E Land Account Land Credit Land Total <br /> Facility Account Facility Credit Facility Total <br /> Exempt ❑Yes No How Determined Total AmouoM_� <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 AMOUNT§LISTED HAVE <br /> SEEN 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 assessment and tha conditions of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />