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PASGO COUNTY, FLORIDA <br /> �s <br /> Permit No.. <br /> DatePermltted <br /> ~Builder Name/Owner Name 1 D 4 6" Control W." <br /> County Parcel No. D —4, zJ b(,3 6 61 MID zl a SubDiv: &► Uartcb. <br /> Address/Locadon Z <br /> Classification/Type of Usg _�—W, <br /> TRANSPORTATION IMPACT FEE , Rate: Sq.Ft Unit: <br /> Exempt ❑fifes No How Determined <br /> Impact fee Amount $, ai�J/�1 Gam} Zone No, TAM <br /> SCHOOL IMPACT FEE <br /> ( Account (056) Single-Family Detached House Amount $ <br /> (OM- Mobile Home <br /> i (058) Other'Resldentiai <br /> 23)_ Collection Fee <br /> Exempt 6 Yes..❑No How Determined <br /> PARKSAAND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation Total <br /> Zone _"T TOTALAMOUNT : ,o. <br /> r <br /> Exempt ❑Yes []No How Determined <br /> LIBRAR ;FEE' ! <br /> Land Accounf Lan&Credit Land Total <br /> Facility Account Facility Credit Facility Total <br /> Exempt ❑Yes ❑ No How Determined Total Amo <br /> RESOURCE FEE ERU <br /> TOTAL"AMOUNT <br /> Prepared By Chocked By. <br /> NO CERTIFICATE,OF OCCUPANCY...WILL-BE,lSSU1D.OR,FINAL INSPECTION <br /> PERFORMED Wit THE T&m-AMbi li TS LISTED HEAVE <br /> • BEE,I+t�P�1lO AND <br /> RECEIPTED FOR BY A CENTRAL PERMIITINGI OFFICE•OF PASCO COUNTY <br /> Acki(owledgement below:does not Implyacceptanoe of Qat>aurence but elmply.recetpt.a>a.cepq.of t4la form,p!adA9 - <br /> ' the bid pedntt ftnekoh notice ofthta m aismentand tho'condittons.6f paymentfor'same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />