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RASCO COUNTY, FLORIDA <br /> F k Permit No. <br /> r Date Permitted — <br /> Builder Name/Owner.Name lQopl� AMW Control# <br /> County Parcel No. Z zL 0 aoea)/X2 SubDiv: <br /> Address/Locatlon � <br /> Classification/Type of Usq <br /> TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: <br /> Exempt ❑Yes Q No How Determined <br /> Impact Fee Amount Zone No. TAZ: <br /> SCHOOL IMPACT FEE , p ! <br /> Account (056) Single-Family t)etached House Amount $ <br /> (057) Mobile-Home <br /> (008) Other Residential <br /> 123) Collection Fee <br /> Exempt [�Yes No How Determined <br /> PARKS ANDNRECREATION FEE- <br /> Land Account Land Credit Land Total <br /> Recreaton Account Recreation Credit Recreation Total <br /> Zone __ TOTAL AMOUNT $'•��a�� <br /> Exempt 0 Yes No How Determine2* <br /> LIBRARY FEE <br /> ' Land Account 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 Checked By <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUEQ OR FINAL:INSPECTION <br /> RF PEORMED UNTIL THE70TAL.AM04NTS_LISTED HAVE <br /> BEEN.P,AID:AND' <br /> RECEIPTED-FORZY A CENTRAL`PERMith d.OFFICE•OF PASCO COUNTY <br /> Acknowledgement below does not Imply acceptance of concurrence,but simply receipt of�a copy of_tWo form,placing <br /> the building pannit'owne-on notice of tlile assessment and ttio conditions of payinent for earne. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />