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i <br /> i <br /> RASCO COUNTY, FLORIDA <br /> Permit No, <br /> F Date Permitted 7 /J, <br /> Builder Name/Owner Name 104t M Control# <br /> County Parcel No. 'SubDiv: a <br /> kg <br /> Address/Location <br /> Classiflcation(fype of Use � �(� f <br /> TRANSPORTATION`IMPACT FEE Rate: Sq.Ft Unit; Z <br /> i' <br /> Exempt 0'Yes ❑ No How Determined <br /> Impact Fee Amount Zone No. TAZ: <br /> SCHOOL IMPACT FEE �ff <br /> Account (056) Single=Family Detached House Amount $. FlTi / r : <br /> (057) No'bile.Home <br /> (058) Other,Residential <br /> 123) Collection Fee <br /> €. Exempt [�Yes Q No How Determined <br /> E <br /> i. PARKS AWRECREATION"FER <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation Total r <br /> Zone " TOTAL AMOUNT $ 7jo ! <br /> { Exempt ❑Yes ❑No How Determined <br /> LIBRARY FEE <br /> Land Account. Land Credit Land Total <br /> Facility Account Facility Credit Facility.Total. <br /> Exempt [j Yes 0 No How Determined Total Aknount <br /> RESOURCEfEE ERU <br /> TOTAL AMOUNT <br /> Prepared By Checked By <br /> NO CERTIFICATE 0F,OCCUAANCY:WILL BE IESUEt3.©R FINAL.:iNSPedtiON <br /> PERFORMED'U 10TNTIL THI" AL AmoQh`i'S LISTEMWIE <br /> B�i~I+t;PA1D"ANo, <br /> RECEIPTED'FOR BY A CENTRAL PERMtTTINGi.QPPiCE.'OF'PASCO COUNTY <br /> Acknowledgement betbw.does-pot lmpiy,acceptance of concurrence,but slmpty.receipt of a copy.of thlp form;placing : ~ <br /> the building'peanit`owner on notice of this assessment and tha a fidrdons df payment forsaime." <br /> MATE 'RECEIVED'BY <br /> RECEIPT NO. DATE BY <br />