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pI <br /> Permit No. ! j <br /> Date Permitted' I 2Z <br /> Builder Name/Owner Name • YkIMMAk Control#* - <br /> County Parcel No.D 1' 4 I! (1 Z60 00000 0//0 SubDiv: <br /> i <br /> Address/Locatlon 7' Slk& A,6 <br /> � <br /> Classiflcationtiype of Usg C C i ! r <br /> TRANSPORTATION IMPACT FEE . Rate: Sq.Ft Unit: i t b 2!' <br /> Exempt ❑fifes [Q No How Determined <br /> Impact Fee Amount . 3Z Zone No. TAZ: j <br /> c <br /> . SCHOOL IMPACT FEE ``! <br /> f Account (056) Single-Family Detached House Amount <br /> (057) Mobile Home <br /> 1 (0513) Other.Residentlal <br /> d <br /> 23) Collection FeeExempt Yes . 0 No How Determined <br /> PARKS AND.RECREATIOWFEE <br /> Land Account Land Credit Land.Total <br /> Recreation Account. Recreation Credit Recreation Total. <br /> Zone __ TOTAL AMOUNT ' <br /> Exempt ❑Yes. [ No How Determined <br /> LIBRARY FEE ! <br /> Land Account Land Credit Land Total <br /> Facility Account Facility Credit Facility Total _ <br /> j;. <br /> Exempt ❑Yes [Q No How Determined Total Ambu . <br /> -RESOURCE FEE ERU <br /> TOTAL AMOUNT <br /> I _ <br /> Prepared By i Checked By <br /> NO'CERTIFIGATE OF OCCUPANCY WILL BE ISSUED..OR FINAL INSPECTION <br /> PERFORMED UNTIL.THE TOTA.L.-AMOL.INTS I.ISTEb'HAVE i <br /> BEEN PAID <br /> RECEIPTED FOR BY A CENTRAL PERMiTTiNG OFFICE.-OF PASCO COUNTY <br /> { <br /> Acknowledgement below.dces Rot imply.accaptance.pt.6ncurrence,but slinply receipt of a copy of ihla form,placing <br /> the building pennit owner•on notice of this assessment and tha'condfttons of paymant for GPM <br /> j <br /> i <br /> DATE RECEIVED BY I <br /> RECEIPT NO. DATE BY <br />