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' PASCO COUNTY, FLORIDA <br /> ArMit No. <br /> ' Date Peanitted <br /> Builder Name/Owner <br /> Name, /a Control <br /> County Parcel No. SupbDiv: <br /> Address/Location <br /> Cles5l8cation/Type of Usq J� �" jfi <br /> j <br /> { TRANSPORTATION IMPACT FEE Rate: Sq.Ft Unit: Z4 <br /> Exempt ❑Yes ❑No Haw Determined ' <br /> ! Impact Fee Amount $.-:L'(v 3z Zone No. TAZ: <br /> I SCHOOL IMPACT FEE f <br /> Account (058f Single-Family Detached House Amount $--, / ; <br /> (057) Mobile Home <br /> (058) Other Residential <br /> ! 123) Collection Fee <br /> i <br /> Exempt Yes ❑No How Determined <br /> PARKS AND RECIFINATION FEE I <br /> Land Account" _ Land Credit Land Total <br /> r Recreation Account Recreation Credit .Recreation Total <br /> Zone TOTAL AMOUNT S 76 ��31 <br /> Exempt ❑Yes ❑No How Determined <br /> LIBRARY FEE <br /> Land Account Land Credit Land Total <br /> Factitty.Acc6unt Facility Credit Facility Total <br /> Exempt ❑Yes ❑No How Determined Total Amount ` � ! <br /> RESOURCE FEE , ERU <br /> TOTAL AMOUNT <br /> Prepared By c Checked By <br /> NO CERTIFICATE OF OCCUPANCY WILL 8E ISSUID:OR FINAL,INSPECTION <br /> PERFORMED UNTIL THE TOTAL AMOUNT&LISTED HAVE <br /> . BEEN PAIWAND <br /> RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE-OF PASCO COUNTY <br /> Acknawtedgoment balaw does not Imply acceptance of concurrence;but simply receipt ofe copy or this form,placing <br /> the building permit owner an notice of this assessment and the conditions of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />