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'ASCU COUNTY FLORIDA <br /> l _ Permit No. <br /> Date Permitted <br /> Builder Name/Owner Name ��. / fe � 3 Control W " <br /> County Parcel Noo 2G� 21 l 2Z MbDb 03_A2GubDiv: <br /> �S ,l <br /> Address/Location <br /> Classiflcation/Type of Us Q I,e. <br /> TRANSPORTATION IMPACT FEE , Rate: Sq:FtUnit- <br /> Exempt• Q Yes Q No How Determined <br /> Impact Fee Amount Zone No. TAM <br /> SCHOOLIMPACTFEE <br /> E Account (050) Single-Family Detached House Amount $ <br /> (057) Mobile Home <br /> (908) Other Residential <br /> 23}- Collection Fee <br /> 1 <br /> Exempt [�Yes..Q No How Determined <br /> PAM AAND'RECREATION FEE• <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation <br /> /Total <br /> Zone TOTALAMOUNT <br /> Exempt Yes -[]No How.Determined ' <br /> LIBRAW'FEE' <br /> Land Accounf Land Credit Land Total <br /> Facility Account Facility Credit Facility Total <br /> Exempt ❑Yes 0-No How Determined Total Amount <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT <br /> Prepared By Arc U Checked By <br /> NO CERTIFICATE OF;OCCUPANCY.LWILL BE ISSUED OR FIN&JNSPECTION <br /> PER<:OIBUIED[1NTik 1'oE t6t.-L Amd.ANTS LISTED hAvit <br /> BEEN.-PJ.HAND., <br /> RECEIPTED FOR BY A CENTRAL'PERMiTiiN®'OFFics.oF PA$CO COtlNTY <br /> AOufaMedgement below does:not lmply acceptance of conaltrence,but si►ppiy receipt of a.copy of.thle form;placing <br /> tt�bu1ldtng permit cwnaFon notice of this assessment erid ttia coitidigons of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />