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<br />PASCO COUNTY, FLORIDA
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<br />.............,....,.-...,"'.'''..............~___,.........,.,~.......'',n..'''''_..~......_.."__."..._'__.............~.,..._._"'..,._.-..".._~.,..._........._.......,.,................,,'~....."'____.
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<br />Builder t'lallle/Owner Name .fl~1_1-
<br />C;Ollllty F'8r(;ell'lo,
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<br />Permit N\). ...--.-.d:...Lfc23 ._____
<br />IJate Pennltled -L~/~_z_
<br />J::~__.n._ Control I/- __ _______n n___ __
<br />SubDiv:
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<br />--_.__._-" -~._.- -+---.-- -..--------
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<br />I' .'.. /1 .t", J; .-rj
<br />Add res s/Locatlon .l/2b.jL-.C:!:...c.~~Lec-;f-:C.' -kv/~--._______n_._.__.___u..._,_.._ __ u. ___
<br />Classiflcatloll/Type of Use_ .3-1. ~#~.f,,-~J...,J.~:~_ ___ __.______. ___
<br />TRANSPOHTATION IMPACT FEE Rate: ____________ Sq n Unit: ----.--.-_._m____
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<br />Exell1pt I_.J Yes ,[;yNo
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<br />How [Jetermlned
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<br />--~'-'---. .-....--..-----___... -'0 ____._ .______~
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<br />Impact Fee Amount -J.--.4-.-t'~,_h
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<br />Zone No. TAZ:
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<br />..-------..-..-..----. -.._'---~' .... --~.- .-.~._.._--,...-
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<br />~~~:nM(~~ZT ~!i~~;~~;;I;~J::::::IOII:_- A::~,;---~-4~z~~..~.----~~.
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<br />(051) Mobile Home
<br />(058) Other Residential
<br />JI2:3) Collectlqn Fee
<br />Exel1lpt [ ..1 Yes Ll./~6' Ilow Determined ______.__.____ ...'_._____.___. __'_" _.. .__
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<br />...-.-.-....---...-.-.- .._-----~--_....---"..._._..._.. ~_.. ----.
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<br />- - .--.-.. ~'---' ..- ._-~_..- -.--, .-- ----- .. ..- .....--.-.-. ~
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<br />p ARRsANfj1H~(~REATlotrFEE""-~-~:-.
<br />Land ACCOlltll La.nd CferJIt
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<br />~ ..;.....-.-......."''''''.."...."...,,*-e-.-O .,o'!........_""....'"'''~,_-...- ,~......__ --..._...-.-,......_.__,,.,..___ ",.........._..
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<br />Land Total
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<br />r~ecle;'ltil)11 Acc( H It It
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<br />necreation Credit
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<br />Her.reation Total
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<br />LUlIe
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<br />'renAL AMOUNl.t____ __ ____
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<br />/EXEmlpt
<br />...-
<br />,
<br />
<br />I Yes ,-] No
<br />
<br />Ilow Determined
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<br />- .---.--.-.--.-....-. .~'n___._.~._. '--"__"_~_U" .....__....__ ~._
<br />
<br />T.lsfiA R'lFF.E"'.'''.....''....''. ,.. "...._~._.. '...-- ,..".-.,.-.....-...,--'-----.-,-,_........o.=__.._..".~._,..__..,.__.._...~_.'"'.'"._." ""_..
<br />
<br />--.--. ..
<br />Latlll ACCOlltlt l.and Credit -.---..- Land Total
<br />----. - --- "'""- .... .-.........----..:=:::.-;::._----_.~_._-- -. --- .- .-...._~-_._--..-....__..._~,-_._----
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<br />Facility AC(;()lIllt
<br />
<br />..-"~
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<br />P'8()illty Credit ..__.___._._.___.. Facility Total
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<br />Exempt [J.Ye~"- i'-] No How Delermlned _~.~._ Total Amount ___...__...._..__
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<br />'RE'SOlIRcEtFEi~.'.-."..'m~'-_-,,-........~._-_...._----- i ........-. Effij'---.--~_..-.-"-.-.~-_...-'"-.
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<br />
<br />TC)lAL AMOUNT ~:-.UlJ)..._-;jLp:..-~-l -'-"-____'_H________. _...____
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<br />._...~.,. ,.. . "-'--' "p,.,.,. "","".~ ""'.~ .~~.......--,-~,....,o...,.". "4.,..."...."......,"..,.>>.'~....."....,_,,_........~. ,..,........ .-......'..~....._40-.-.._....... _
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<br />--....- "'"""""-'''-~'''''''.''''''''=''-'''''-'-~' ,.,...,. ..-....,--...,......~,,-~-~=........
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<br />Prepared ny "'.H_
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<br />..._______ Checked By
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<br />NO GEHTIFICATE or OCCUPANCY WIl.L. Bt: IssueD OR FINAL INSPF.CTION
<br />PErU:OJ~MEU UNllL THE TOTAL AMOUNTS L1STEU HAVE
<br />BEEN PAID AND
<br />rU:GEIPTL~D FOR BY A CENTRAL PERMITTING Of=FICe ()F PASCO COUNTY
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<br />Acknowledgement below does not Imply acceptance of concurrence, but slrnply renelpt of a copy of this form, placing
<br />the building perllllt owner on notice of this assessment and the conditions of paYlnent for same.
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<br />_._'--~_._.. -'-""-.-.~..-.- ..-_... .u..__n_..__.__ ---....- ..--.....---..".---.-. -----
<br />
<br />DATE ReC
<br />RECElf'T NO. -J~ IJAI E :z};/p Jprj BY
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