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<br />
<br />PASCO COUNTY, FLORIDA
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<br />........................_,...."'.''"'...............".'-'-",.......'"'''-,~,...........'-''-''-~........''---...............~.
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<br />.~......--....-...-..............._...... _.........._..---.......-.....,....,~......~.-....-
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<br />Irnpact Fee AlTlOllnt .~.._,_
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<br />Zone No.
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<br />TAZ:
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<br />'sCI'ioc[1MPACT FF.E---~..-..~--_..._---~~'--~~..-....----~-....._-_._._~--_....__~
<br />Account (056) Single-Farnily Detached House Amount $ ___'.__ ___...__'_..__"_,...._...,.. ,__
<br />(057) Mobile Home __.____'_,..___,..,___,__,__,_,.
<br />(CJ58) Other Residential _____'..______._.."..__..,____.
<br />
<br />Exe III p t [J! ~ 28 U~~on F~.7ow D eten nln8r1_ _.__ _. . ___. __. . ______ .. _._m._ _ _
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<br />'p ARf<S AND' RECREATION FEE ..-,.--.--.-----~.~._------..--_.__.._,_._.
<br />Land ACCoIHlt Land Credit Land Total
<br />
<br />-'~-'-_._.- -,..... .._~--._- ---.-
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<br />---'-'--.,- - -.-- _.._'~----_.-
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<br />Recreation Account r~ecreation Credit Hecreatloll Total
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<br />-~~"._..-._- - '---'-'-"- ----~._-_._--..~_._, ~- ---"--'-"-''''~
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<br />Zone
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<br />TOTAL AMOUNT
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<br />..~-_.,--
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<br />Exernpt [J Yes [] t'Jo
<br />
<br />Ilow Determined
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<br />..........-,.......,,_...u.....;,~___........,_.~_...,~ ~_
<br />LIBRARY FEE
<br />Land l\ccOlJl It
<br />
<br />- m_..._______.___..____ . .__..'~ ..._. ____.. _." _ _____."__.__ __._. ,____ _'. __._..
<br />
<br />,._~""..,-...-----....._.-.........--"".._,.._._.-"-""-._"'-~........----..."-~_._"."""-"'--.........._~.,,..._-,..................""-'->...--..._.....................~_.........."'..........._--'-._......_........_,--_._-"--....._._,...~
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<br />Land Credit
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<br />_.,-..._-----_.._---~~---.__._-
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<br />Land Total
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<br />Facility ACclllJl1t
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<br />-_...". .._....4____.___.._....,____.____
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<br />Exempt [-j Yes [J No
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<br />Facility Credit .___.._.'_,________. _,... Facility Total "____________________.
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<br />How Deterrnined Total AnlOlIllt
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<br />----....--.,---- ._--~--_.__...-.__..,~---
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<br />REsoTIFi'C'E-FEE"""--"--'~-'~-'~---'--------'.
<br />r ..
<br />TOTAL }\MOUNT . !.',
<br />1_____--,..
<br />
<br />"" ...--....-'""----_...."""-..'...__._,~~-_..--.-....
<br />ERU
<br />
<br />. -._.,.,._.._._.......'~-~."-_. '----...-.-.----- -"'---","-,-
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<br />....-.......-.... '-"'-'-'''' ,......~-""..~----..._'~._-~----~-,_..__...__...._-----~_._._--_..."_._"_._.__.._--_..._..._-~
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<br />Prepared By
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<br />......"..'.'---..______________ Cllecked By
<br />
<br />---,.'".-. ~--..----_..-" -'-... --'--.~-,--..,--..>. '_.b.____..__. ~_'_.__
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<br />NO GEHTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
<br />I)ERPORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE
<br />BEEN PAID AND
<br />RECEIPTED FOR BY A CENTRAL PERMITTING OFFIGE OF PASCO COUNTY
<br />
<br />Aclilluwledgernent uelow does not Imply acceptance of concurrence, but simply receipt of a GOPy of this form, placing
<br />tile blJlldlng pennit owner on notice of this assessrnent and thE! conditions of payment for same.
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<br />-.----,-,..-."-.. ,,-- ---_. ..~. '-.-,.-- -._~".. ._..__._.__._---~.~-_._-_._._---
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<br />DATE
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<br />REC;EIPT NO.
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<br />", ,.' DATE
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<br />,-,-----'-.1.___......, __,
<br />RECEIVED BY
<br />;/
<br />i 't.!
<br />BY i !\ ( , '
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<br />-l--~--- ....--.---.
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<br />_4.__ _._.....___"____.__~.,_~_._._
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