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4 <br /> PASCO COUNTY, FLORIDA <br /> Permit No. ` <br /> Date Permitted ©-Zo— <br /> Builder Name/Owner Name Control#' <br /> County Parcel No. Zj� 21 01?_V 00190 J 0 (a-c7_ SubDiv: <br /> Address/Location <br /> t <br /> ,< <br /> Classificationtrype of Use �} If <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: -2j <br /> Exempt [] Ves ❑ No -How Determined <br /> Impact Fee Amount Zone No. TAZ: <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 /> t Exempt Yes ❑ No How Determined <br /> 1. PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation Total <br /> Zone TOTAL AMOUNT $ <br /> x= Exempt ❑ Yes ❑ No How Determined' <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 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 the building permit owner.on notice of this assessment and thq conditions of payment for some. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br /> 1 ~ J <br />