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<br />
<br />PASCO CQUN1"Y, FLORIDA
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<br />-...........'-"".,.-.,.'-......~:....u...a..w...J...-........:.-,__.,;...~~~.......;.,_...."".:;.-.,;.~......."..........__--......-.............,~..........
<br />
<br />'.. .,-....---.._~..........,..-..."",......~----......-
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<br />Permit No. ---"_HH_i_z (________
<br />Da te Pe n II i tteel..__ ,f',ool~;/l(..-L_
<br />
<br />Bllildel Name/Owner l\jame
<br />
<br />/ .
<br />l;'\j'r 1\ 1/((,<1/ \ j Control #
<br />---7----------..---- -~--------...._.____. _.._
<br />
<br />Clllllll Y P alcel No./J) L ) it ?fr.,,!,",, ._0.'~L<'_. ___. _ __ S 1I b D Iv :1/,_",_,-t '--'J""-'''-'
<br />
<br />Address/I ()cation ,_1/71 Lt_ -JI!,J~'~L~'_J-o--oo------.~---------- ____________ __________ ,." _ _._~_
<br />\ -. (i ^ 11,
<br />Classificalioll/ rype of Use ":)Jlc.(1tQ---.----L::!:Ul,,~~J_u.--L.u.'=',(..-~J~~~{f---oo---.,.____,__.__
<br />
<br />lRANSPOfHATION IMPACT FEE Hate: __.__ ______...__ _ Sq Ft Unit:____.._,_._.____._
<br />
<br />Exempt [u I Yes [aNo
<br />
<br />flow Determined
<br />
<br />-~---"~-- '---~'----_._-._--,..- '"-"'.'--". '.. -~._--_.__.- "..'.
<br />
<br />Impact Fee Arllountl J.t1j(!) (
<br />
<br />l.one No.
<br />
<br />TAZ'
<br />
<br />scHooT.1MPACT FEE--"--..----~-..oo-~-.".~~~.,.~..."..,~"'~.-""-.- .'
<br />
<br />.'~ ......,. -..~..........-.....__._~'......~....w." ........-'-.._.....___k... ....., '''''''' ....... .........,...'......
<br />
<br />Ac(;uunl
<br />
<br />Exel npt
<br />
<br />(056)
<br />(057)
<br />(05B)
<br />1'123)
<br />I I Yes
<br />
<br />Single-Family Detached House
<br />Mobile Horne
<br />Other Residential
<br />Collection Fee
<br />1..:-1 t~o Ilow Determined
<br />
<br />ArnoLlnt
<br />
<br />$ I, (, '7 '/
<br />".'''._'-, ....-. .1.__._,,-,-- 0000,. ,_ .,_..
<br />
<br />_.....-.. ....-.--..- - _._~. ------..-- - --._-. - "-'-~--..
<br />
<br />-._--.._- "...-.,-., .~_.,' ".-......---.-- - _.
<br />
<br />._._-~-----_.._--- --*-"--- ..--.
<br />
<br />"" ---...-.-.-----, .<__ .____m____..
<br />
<br />. P AFH<s AN f1""REC REA Tf6'N FE E.'-"-oo-'~'-~--,--,--~----~,,,-~,~,,,-,~,,,__oo,_u__,_,_-.-."..___.
<br />Lalld /\(;COI mt Land Credit Land Total
<br />
<br />Hecl eatioll AC:CClllllt
<br />
<br />Hecreation Credit
<br />
<br />Hecreation Total
<br />
<br />Zorle
<br />
<br />TOTAL AMOUNT ,J.._____. ,_,
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<br />Exempt [] Yes '--I t'-lo
<br />
<br />How Determined
<br />
<br />. -.....------.--...-.- -.~-...._.__..---_.__. -....,.. -----_.~_.
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<br />.......~..,.........-...........-........-......_, ..............-.-.......:...-..-....,.......----.-.-......,~..-...-...........-..........-,~.~,.-...~'"'......., -.-..~~'-'----.........-........-_.~.-..~~.....,.......~,."'~,..'"...'_.c.._....~.I_............,~____.........._~__...~~......_~"......'.................."........._,__....__............"..............____
<br />
<br />LIBRARY FEE
<br />l.E:md AI~co(1I11
<br />
<br />Land Credit
<br />
<br />Land Total
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<br />Facility ACCOllllt
<br />
<br />Facility Cl'edit
<br />
<br />Facility Total
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<br />Exempt 1.1 Yes [J No
<br />
<br />How Determined
<br />
<br />Total Amount
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<br />.-_.~..._~...........~-----.....-......._,--",--._-""'""'--..................--...-....~"-"-.............~
<br />
<br />RESOURCE FEE
<br />TOTAt, AMOUNT
<br />
<br />-..-."~- ~....~. ER U ~'~~_.,.-_..--..-._..._....,.-....~--
<br />
<br />,..--- -----,..--., -_.-....__.-._-..__.~--~....._....- _._...
<br />
<br />............., '-""'~"'~"" "'~''':''''.'-~.'..,- ", ......; ""................_................<---......._.............~~..~...--....._...~-~......~~..... --."""---.......~_.".....~.._-.............-.....~.~."--...........~...._~-.......,""""'..........-.............._~..~....._..~......~,...............""--"'..c.,.......,....
<br />
<br />PI epsrecl Hy
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<br />_ --.-. _________00_00 Checked 8y
<br />
<br />-.- - .._----------_....._,-,.._---._---~-....,-_... .---.------
<br />
<br />NO GEHTIFICATE OF OCCUPANCY WILL BE ISSUEfJ on FINAL INSPECTION
<br />PERFORMED UNTIL THE TOTAL AMOUNTS L1STl:D HAVE
<br />BEEN PAID AND
<br />RECEIPTED FOR BY A CENTRAL' PERMITTING OFFICE OF PASCO COUNTY
<br />
<br />Aclillowll:idgernent below does Iiotlinply acceptance of concurrence, but simply receipt of a copy of this form, placln(J
<br />1I1b Illlilding permit owner 011 notice of lids assess/nent and the conditions of payment for same.
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<br />DATE
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<br />..f~EC~ IV-Et)" sT---
<br />I
<br />
<br />RECEIPT t~O. I
<br />
<br />).
<br />
<br />DATE
<br />
<br />BY
<br />
<br />I ,
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