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w <br /> PASCO COUNTY, FLORIDA <br /> Permit No. .� <br /> Date Permitted <br /> "Builder Name/Owner Name kA� �2 /_..Z= Control#' <br /> County Parcel No,- O Z6 al 6 �)&� <br /> J ' 0ubDiv: <br /> Address/Location <br /> Classificatlonft'ype of Usq LS/Y I <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: Z Z91 j _ <br /> Exempt. Lives Q No How Determined <br /> Impact Fee Amount $, Z 1 Zone No. TAZ: <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $ <br /> (057) Mobile Home <br /> f (058) Other Residential <br /> 123) Collection Fee <br /> Exempt Yes. Q 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 s ' 7lP i C <br /> Exempt ❑Yes ❑No How Determined <br /> LIBRARY FEE <br /> Land Account Land Credit Land Total <br /> Facility Account Faculty Credit Facility Total <br /> Exempt ❑Yes ❑ No How Determined Total Amoun>tC -. <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT <br /> Prepared By 1 — Checked By <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTIL THE TOTAL AMOLINTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE-OF PASCO COUNTY <br /> AcliftWedgement below does not Imply acceptance of concurrence,but simply recelpt of a copy of this form,placing <br /> the building pemdt owner on notice of this assessment and the conditions of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />