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` RASCO COUNTY, FLORIDA <br /> Permit No. • "(49 <br /> Date Permittedy <br /> Builder Name/Owner Name 1� 4�f'&t vyt 7'L• n#rol#' <br /> i 2 - 67-14 � a�1 S <br /> County Parcel No. ��_�Z.($- i' ^bt7t7 dZ SubDly: <br /> I <br /> Address/Location AI-1 <br /> Classification/Type of Use ,/ <br /> TRANSPORTATION I i MPACT FEE - Rate: Sq.Ft Unit: 2,t <br /> Exempt n Yes �I No How Determined <br /> Impact Fee Amount .$.sl �� � Zone No. TAZ: <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $ <br /> (057) Mobile Home <br /> (058) Other Residentlal <br /> 123) Collection Fee <br /> Exempt [ Yes a No flow 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 IQ No How Determined.43 <br /> i LIBRARY FEE <br /> Land Account Land Credit Land Total <br /> t ' <br /> Facility Account i Facility Credit Facility Total <br /> I <br /> Exempt ❑Yes i Q No How Determined Total Amount <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT <br /> Prepared By Checked By <br /> j <br /> NO CERTIFICATE OF OCCUPANCY WILL.BE ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE <br /> j BEEN:RAID AND <br /> RECEIPTED,FOR BY A CENTRAL PERMITTING OFFICE.OF PASCO COUNTY <br /> w: Acknowledgement below does not Imply acceptance of concurrence,but simply raceipt of a copy of this form,placing . <br /> i? the building permit owner on notice of this assessment and the conditions of payment for same. t <br /> 4. . <br /> I <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />