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;RA CO COUNTY, FLORIDA, <br /> _ Permit No. J' 'D <br /> Date Permitted JZ' ' <br /> Builder Name/Owner Name u L` !y Control#' <br /> County Parcel No. (� 2-CR.ZJ.d tZ�?t L SubDiv: <br /> Address/Location <br /> Class(flcationfType of Usq <br /> TRANSPORTATION].MPACT FEE Rate: Sq.Ft unit: ZZ T <br /> Exempt ❑Yes [] No How Determined <br /> Impact FeeAmount _ _/ Zone No. TAM <br /> F <br /> SCHOOL'IMPACT'.FEE <br /> Account (t)5t3} `Single-Family Detached House Amount $ <br /> (Q57) Mobilo'Horne <br /> (058) Otkit Residential <br /> 123) Collection Fee <br /> Exempt [ Yes ..❑No How Determined I <br /> PARKS-AND'RECREATION;FEE- <br /> Land Account Land Credit. Land Total <br /> V <br /> Recreation Account Recreation Credit Recreation Total <br /> Zone TOTAL AMOUNT $ 7� <br /> Exempt ❑Yes ❑.No How Determined'l <br /> LIBRARYTEE <br /> Land Accounf Land Credit Land Total <br /> Facility.Account Facility Credit Facility Total <br /> Exempt ❑Yes ❑ No How Determined Total Amount <br /> RESO,URCE,FEE ERU <br /> TOTAL AMOUNT <br /> Prepared By Checked By <br /> NO CERTIFICATE;OF OCCUPANCY,WILL BE ISSUED OR FINAL INSPECTION <br /> PERFORIV EP UNTIL THE TOTAL AM60k.tS LISTED HAVE <br /> BEEN PAID'AND. <br /> RECEIPTED FOR BY A CENTRAL PERMiTTINt3 OFFICE.OF PASCO COUNTY <br /> Acknowledgement below does not imply acceptance of concurrence,but simply racelpt of a copy of this form,placing <br /> the building permit owner on notice of this assessment and the conditions of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />