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<br />PASCO COUNTY, FLORIDA
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<br />--"-."-"~-"""""'-"'-~~"""""'<-'"''''''''-''' ............_~_"'--...'.h"""'~"n".'.........~.,~........_...-._......~..""...................,...-'-"".~__~__.W..........". '_"-_'~_" _........._......___.~~""'........ ...........,_..__.....".....'" "..."'-.....__,...
<br />
<br />I low Deterrnined
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<br />---.---, ---...--..--.- .".'--.-----...-.._ - _'~n_..______,_..
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<br />Impact Fee An IOllntJ..,
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<br />Zone No.
<br />
<br />TAl:
<br />
<br />s'cTif) ()i:1MP ACT FE E""'~~'~' ....-._._~-~.,_."~.~.~....,----. --..._-.."~.
<br />Accuullt (056) Single.Farnily Detached HOllse Amount
<br />(05?) Mobile Horne
<br />(058) Other Residential
<br />('12::\) Coll}ilction Fee
<br />Exempt I] Yes '[1 No Ilow Determined,.______,_..,
<br />
<br />.' -'. .-........,..........._ < ~""'..->lo.____~..._~ .~ ~".""'.. .,,-.._.,. _~ ___, _..,.. ........ ,...._...
<br />
<br />$
<br />
<br />'.___. ___.no _.,.. .._._.....,..._,,__.....
<br />
<br />..~.~-_.__.---_._-- --. _.h '_, .'._~_..____..___
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<br />PARks 'A Nfj'REC REA liON FE E .--...-_.~-,_..-..,.."'-_._~_.._~.. -"~'_... .-----...~.._"",....__u__.__...__._.. __'_'__
<br />Lalld ACCCJI II It Land Credit Land Total
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<br />PecI8ctliun l\cculInt
<br />
<br />F<ecreatiO!l Credit
<br />
<br />f~ecreation Total
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<br />ZOl18
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<br />Exelnpt [j Yes I] r~o
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<br />TOTAL AMOUNT ,~________ .-'____.d,.,
<br />
<br />How Determined
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<br />--'-"~ ~_. -'-..------... .-..,,"-,~--- ."-_._------..._--~,... -'" .--..~_._._'--.._~-......-',."---,_.~,~. ..'-..--.--.------...-,....--....--..------.---.-
<br />LIBRARY FEE
<br />Land 1\(~C()lll II Land Credit L.and Total
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<br />---.-----..-----."-.. ._~,~- ..-.------~---.___._ ._u__._..... _ -. ._. _____. _"_~..~.._._ _ ._. .__ __._.___
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<br />_.-..-.. .-----.--- --- .-- --._-~-..__.
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<br />Facility AC(;(JUllt
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<br />..____'__u,_________ facility Credit "-'-'--_______u______ Facility Total
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<br />Exempt L.J Yes [J No
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<br />,--- +--"'--~._"._ "h__.._,. '_.~.._..,..
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<br />How Determined Total Amollnt
<br />
<br />----------.. '---'- ----~-'---.,--____.A,..h._._., _____
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<br />RE.s6DFfc.EFEE.---:----.~--~-~~-~-.-~--~-.~. ERU
<br />TOTAL I\MOUNT I___L~_ _i:_.__~__n___...__.__,..
<br />
<br />.......'.......-....~--,- .."....,.....~..,.........,......, -~.............-"....-._-
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<br />.---.. ...,".,... .".._-_......_._."'~~_._.".._._~-~~.__.~_.__.....__.--..~-_.---~--_.-.._~_._._.._,-_._~.=~.---...__.,-_.....,- "'."---""'--
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<br />Prepared 8y _
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<br />".- - -- -- --..-.- - ..-- ----.. - .._._~--"._-- ------._~~.
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<br />Checked By
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<br />_. ---..----..-.....---,.. .._" -.... ....-..--.. ...-.._..,,_.~_.._--
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<br />NO CEFnlFIGATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION
<br />PEfU:O.~MED UNTIL THE TOTAL AMOUNTS LISTeD HAVE
<br />BEl:N PAID AND
<br />RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
<br />
<br />Acl\llowledgelllent below does 1I0t i1nply acceptance of concurrence, but simply receipt of a copy of this forlll, placing
<br />the IJllildlng permit owner on notiCE> of tliis assessment and the conditions of payment for same.
<br />
<br />DATE
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<br />-- -'-'~-"" _. r '"_._,___ _ __.. ______..___________ ,,_ ._-.__ ___
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<br />~_._-_._~----_. ...~--- "
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<br />F~Er,EIVEO BY
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<br />/
<br />.t---...:-_.___...~_.~
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<br />RECEIPT NO.
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<br />/" DAT!::
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<br />f
<br />I
<br />
<br />BY
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<br />, l
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