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i <br /> RASCO COUNTY, FLORIDA <br /> Permit No. <br /> Date Permitted <br /> ^Builder Name/Owner Name Control#' " <br /> County Parcel No. ZS 2 -b/-&4MQ-0l,3�V SubDiv: <br /> Address/Location <br /> ClassiticationfType of Usq <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: — <br /> Exempt ❑Yes [] No How Determined <br /> Impact Fee Amount � .c(� Zone No. TAZ: <br /> i. SCHOOL IMPACT FEE <br /> Account (056) Single-Farrilly Detached House Amount $ <br /> (057) Mobile Home <br /> (056) Other Residential <br /> 923} Collection Fes <br /> Exempt [ Yes . 0 No How Determined <br /> PARKS AND RECREATION FEE- <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation <br /> //Total <br /> ,�// <br /> Zone TOTAL AMOUNT $ b v . <br /> Exempt Yes ❑No How Determined` <br /> tit <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 Checked By <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUEP-OR FINAL INSPECTION <br /> PERFORMED UNTIL THE TOTAL AMOUNTS LISTED RAVE <br /> BEEN,PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE.OF PASCO COUNTY <br /> Acknowledgement below doss not Imply acceptance of concurrence,but slmpiy receipt of•a copy►of this form;placing - <br /> the building permit owner on notice of thle assessment and the conditlons of paytnant for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />