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PASCO COUNTY, FL0RIDA <br /> I <br /> Permit No. t <br /> Date Permitted <br /> Builder Name/Owner Name A.e^ Control#' " <br /> County Parcel No. D at) SubDiv: <br /> Address/Location Z� f' G One <br /> Classit1cation/Type of Use <br /> 4�2 <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: <br /> Exempt ❑Yes Q No How Determined <br /> 33z. <br /> Impact Fee Amount $. l Zone Na. TAZ: <br /> SCHOOL IMPACT FEE , <br /> Account (056) Single-Family Detached House Amount $ 7`j / <br /> '�/r <br /> (057) Mobile Home <br /> ► (058) Other.Residentlat <br /> 23) Collection Fee <br /> Exempt d 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 $ '.7 (o <br /> Exempt [Q Yes [] No How Determined' <br /> ' 4 <br /> LIBRARY FEE <br /> Land Account Land Credit Land Total <br /> Facility Account Faclllty Credit Facility Total <br /> Exempt ❑Yes n No How Determined Total Amount <br /> RESOURCE FEE ERU <br /> TOTALAMOUNT <br /> Prepared By �i' lapChecked By <br /> NO CERTIFICATE OF.00CUPANCY WALL BE ISSUED OR,FINAL INSPECTION <br /> PERFORMED UNTIL THE"TOTAL"AMOVIiTS,LISTED HAVE <br /> BW PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE-OF PASCO COUNTY <br /> Acknowledgement below does not Imply acceptance of concurrence,but simply recelpt of a copq of,dila form,placing <br /> the building permit owner.on notice of ihis assesement and iha i�nditions of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />