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PASCO COUNTY, FLORIDA <br /> Permit No. 4 z <br /> Date Permitted - ! <br /> —Builder Name/Owner Name Control# <br /> County Parcel No. z s�,Z I t�i �1�1 Ol�l�ll suaDiv: ��l <br /> Address/Localion 6 <br /> ClassificationfType of Us@ <br /> TRANSPORTAT40N IMPACT FEE Rate: Sq.Ft Unit: " ;z <br /> i Exempt (]lies ❑ No How Determined <br /> Impact Fee Amount � � Zone No. TAM <br /> SCHOOL IMPACTFEE <br /> Account (046) Single-Family Detached House Amount $ W <br /> (057) Mobile Home <br /> (058) Other Residential <br /> 123) Collection Fee <br /> Exempt (3 Yes C1 No How Determined <br /> l <br /> 4. PARKS ANDRECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation Total <br /> Zane ,TOTAL AMOUNT $ �c?� <br /> Exempt ❑Yes ❑No How Determined <br /> LIBRARY FEE <br /> Land Account 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 QF OCCUP'ANCY-WILL BE ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTIL THE TOTAL AMOLINTS LISTED HAVE <br /> BEERPAIDAND <br /> RECEIPTED FOR:BY A CENTRAL PERMLTfING OFFICMOF PASCO COUNTY <br /> Acknowledgement below does not imply acceptance of concurrence,but simply rece 1pt of a copy of this form,placing <br /> the bWlding parmit owner on notice of thls assessment and the conditions of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />