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<br />PASCO COUNTY, FLORIDA
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<br />JOLt{
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<br />--......"'-_.~-..-""'"..._-----_.-
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<br />~,-..........--_..'-....
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<br />Permit No. ,:J [' 7?-'
<br />_._..~+._-~---_...., --~- -.._-, - .--..---------.
<br />'j Date Permitted _ .{~ :..~f!i.__.!'...,3___
<br />\J 1 (/ 1/, '
<br />Builder Name/Owner Name _!'~:.,-,12~-':u~_L_d_~L!2~'\ '_d__ Control # ------__________.____u_._
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<br />County Parcel No, -3=L.~s.,)u_=::u~J:__C.._()Lf'..O-?_{~C~C' (:J~.___ SubDiv: (:./YbJ.t1.Q_l1t?J~'T!Lt ( (I I)
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<br />Address/Location __" _.i'7 ?o~f..5..___..!:.L'--'!.i-L1:.:~_3lr -~-~d'_--__'--'-___d____m___hu_,,,_____________ '
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<br />Classiflcallol1/Type of Use ----f!..~( \ 1:.d~_:a-'_t~/t1 ) -'--~--~--'----------'---'_'_--d_'_________'_____u_
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<br />TRANSPORTATION IMPACT FEE
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<br />Rate: __;-______~_ Sq Ft Unit:
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<br />Exempt [] Yes l~}fjo
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<br />How Determined
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<br />--- --..----~--._----- -....-----.--..--,.- .-. . ..---.-_.________....__0-.-. ._+_.....__
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<br />Impact Fee Amount --tu__-4__:iEo_.__~~"
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<br />Zone No. TAZ:
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<br />-----_.~--_. .-.-..-.-.... ....----.-.....-
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<br />SCIIOOL1MPACTFEE'~ -~
<br />Account (056) Single-Family Detached HOLlse
<br />(057) Mobile Home
<br />(058) Other Residential
<br />tI2:3) Collection Fee
<br />Exempt LJ1es [] No How Determined
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<br />Amount $
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<br />-----........ ._~-- - -____. _,_ _.~ h_____.___ ~..._ ....
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<br />--_._._~..__._..,----_....--..._--.- -..,....
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<br />---- ~--'-----"-------"" ------.--
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<br />---..-------..------ ..._--_._----,--~-._-_.__.._.__._---
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<br />OPAR~(S AND RECREATION FEE
<br />l.and ,Account Land Credit Land Total.
<br />-.-...-.-.----.-. ----.----
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<br />Recreation Account
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<br />--
<br />F3Sl.creatlorl Credit
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<br />Hecreatlon Total
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<br />Zone
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<br />TOTAL AMOUNT ,_~_____ _'_ _____________..____
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<br />Exempt [rYes [] No
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<br />How Determined
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<br />-.--.-~--,.- _ .-. h'_~__,..._._ ..-...____.._____ __.,.. ____....___,._.._..__ ..- ._..____0
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<br />IiEiRARY' FEE" ""----"'.,'-----..-,...-.-~-.~~--~,--~---
<br />Land Account Land Credit
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<br />-'-..._......------,..._--,.._--~_..
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<br />L~,r)g Total"
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<br />Facility Account
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<br />FacllltygE~dit, ._'_.____.___.___, Facility Total '''__u____._______
<br />Ilow Determined Total Amount
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<br />-.-----...-- --- .----...---...----
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<br />Exempt LJXEls,--EJ'Nc;-
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<br />'RESOURC'e FEE--'-~~
<br />TOTAL AMOUNT
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<br />~ - -..---.....-
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<br />ERU
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<br />~.__._--~_.~ -..-. ...--....---. -. -"--'--'.-'-
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<br />..____.h_._._.._ ',. __.. . __._._._._._._ '__'__._____.__..
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<br />-........,.......~~..-.....-.."" "_..._..,.~..~........"..........~,....,......................-._..............~-........................-....~~..-............................_..._--............~.........-......,.....................----..".,~..--..._-_............--.-.-
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<br />Prepared By
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<br />'Od_, _________.________ Checked By
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<br />_.~-_.-- ----______..,. __'..n'__._.. ._.. ~_. _"_.. ___________'.__._._...._~
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<br />NO CErfflFICATE OF OCCUPANCY WILL BE ISSlIED OR FINAL INSPECTION
<br />PERPORMED UNTIL HIE TOTAL AMOUNTS L1STI::D HAVE
<br />BEEN PAID AND
<br />REGEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
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<br />AcI;nowledgernent below does Ilot Imply acceptance of concurrence, but simply receipt of a copy of this form, placing
<br />tile building perrnlt owner on notice of this assessment and the conditions of payment for same.
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<br />RECEIPT NO,
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<br />_t'~ ,'~'>-lJ DATE
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<br />f4ui{>BY--,~:~~~-::~:::..__:=.
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<br />DATE
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<br />....--..-...--- ..-...-. ........-.-..---.. __"h'___"_h'_'_..______
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