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RASCO COUNTY, FLORIDA <br /> Permit No. � <br /> Date Permitted ._2 _ZeZb <br /> Builder Name/Owner Name k �1t �,�� 2t. Control#' . <br /> County Parcel No. ;j f�v/Q� bDiv: 4 <br /> Address/Location <br /> Classification/Type of IUse le <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: <br /> Exempt n Yes Q No How Determined <br /> Impact Fee Amount $. 1pJ�� Zone No. TAM <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 $ 70 56 <br /> i Exempt Q Yes 0 No How Determined <br /> E LIBRARY FEE <br /> Land Account Land Credit Land Total <br /> Facility Account Facility Credit Facility Total <br /> Exempt ❑Yes No How Determined Total Amon+v <br /> RESOURCE FEE ! ERU <br /> TOTAL AMOUNT <br /> i <br /> Prepared By { 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 assessment and the conditions of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />