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<br />PASCO COUNTY, FLORIDA
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<br />-_..........,........,,.J.......................~~"'-"-"'.""...."'-"',........................-..,~,,c.~......~......"'_........._""".............."''''''''-'_~'''''''.~~_.""..~....u)"'~e_~~..."."'.....""'.............."..,......""'_~....._'"'..~
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<br />Permit No, . .g5.~____._.
<br />,L} l/ /" /! _ Date Permitted . ~I.:.(~=!?;!__
<br />;Ie ~U~ d- It? 4--1.e,VJr-.. f-
<br />Builder Name/Owner Name ~Qr.(L___.___ Control # .____..____.
<br />County P8rcell\Jo,.__/:f ~-?:.~2:L:.C? UJo -.:_c:..'?~.~_() - 02- ?l?_ 8ubDlv: ~t...~~
<br />Add res s/I.oca tlclIl ...__~L[JLn_.~v-~~__~ e~__________.__._.__.__ ..---'.-__'__n___
<br />ClasslfleellDII/l"ype of Use --Sl~~___L~ n_~~____ __ _______ _ __ ____
<br />'nV\NSfJOtrrATION IMPAGT f:EE Hate: _____________ 8q Ft Unit: ._________.___...___
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<br />Exelllpt [] Yes I~J'Kro
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<br />Ilow Determined
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<br />Impact Fee Arn()unt_~_____.L~tf_~_~___
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<br />----_._--,-_.._-~-._._".".- ..-----.,-. "-.-,.-. ---~-- ..--..---.-.,.-.... ----
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<br />Zone No. TAZ:
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<br />----.----...--.---
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<br />......~."~"~-~"-~._~-~-_._.,....~~.".~-_.~~...~_.....~._~_.._.~'~~~.._"'''~~_.__.....,~~.....,_._._,_._.._....._-,....,..,',....~
<br />SCIIOOL IMPACT FEE
<br />Account (056) Slngle..Farnlly Detached I'louse
<br />(057) Mobile HOIne
<br />(0513) Otller Residential
<br />JJ ~3) (~ol!~c~n Fee
<br />Exelnpt 1m I Yes f~ t..Xo How DetenninecJ_._____________________.________.__.______ ________
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<br />AnlOunt
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<br />$ .I ~f'1 ' #--0
<br />---.---.--../--.-.--.-.---- .-- .-.....--........-.
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<br />~.__h"____,.~___. "..---____,4_.~..__. ___.._. _..__.
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<br />------. ....--..----..-----..--."..----.--.---..
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<br />P'AR'ks 'A Nn"REC REATIONFEE .-...-..~--.--~-~--~..-.....~..-~...-~-~.~--~,--...-.-.--
<br />I.and I\ccol/I\t L.and Credit Land Total
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<br />f~e(;1 ealiun Account _____..__..._ Pecreatlon Credit ________.__.__. 1~f;1J2re.atJoll Total _.____._____
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<br />. , ---------~_.-_....
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<br />_--~-..--l'('JT AI. AMOUNT .L_.... ______.____~-.-_. ____.._
<br />-....-.-
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<br />Exe mp I [] Yes [] tb-------n;;;r;.le'mlned _________ _______ __~____ ____ ___ ___
<br />:,.........-
<br />.------
<br />~,.,'-..... ......-..~'_......L......c~._........_._.~..~.....__..___._....,..___.~.....~____.~.'~,..~_~..._,_.._._.....,...__.__._..__,_.
<br />LI B RARY-.Fe1:
<br />L.an(rAr-~c(l11l1t Lallel Credit ~i-:Y:ctat-----_..__.. n.
<br />...- ...---.------- ._-----~ -- --.......--.-...-.. ---.---..
<br />
<br />----------
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<br />Facility j'\CCOlJllt Ea.e+HtyCi:euit Facility Total
<br />. -- --_.~:;:::;=&"'-- ---~---~------.-~-,-- .._------'_.,--,_.._------~
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<br />Exempl ~0"o How Delermlned ______________ Total Allllllmt _______~___
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<br />/'#........---
<br />~L.:._-.""':"-."".-.~._....-.-._~_._~._.~.~~ ~___~_>~'"~_..___.____.."._...._"_,_~._____
<br />tH::SOURCE FEE ERU
<br />TenAI. AM )lJt'JT______.]_L.~lD__.__
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<br />L_l.:i\,".__""____._.__~_______.___.__________._____
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<br />---._'--------..."-~._--._._.-...,"--...,_._-
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<br />Zone
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<br />. """"'--'-' ----""-.. ------..
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<br />_.'-~-_._- ..-.-.--...--...-.------ ----.-.
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<br />Prepared By -n-----..--._________.______n_____.____ Checl,ecl By
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<br />._----------_.,,--~-_.._._._---_._._-,~
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<br />I~O CERTIFICATE OF OCCUPANCY WILL BE ISSUED or~ FINAL INSPECTION
<br />\-:lEm:OHIVlElJ UN'flL THE TOTAL AMOUNTS LISTED HAVE:
<br />BEEN PAID ANt)
<br />RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
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<br />Acl\llowledgelllenll.Jelow does 110t Imply acceptance of conclIrrence, but simply receipt of a copy of Ihls form, placing
<br />IhEl building permit owner on notice of this assessment and the conditions of payment for SBme.
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<br />_._-~ -......_..~-- --- .--.--..----.----.. ----.----.----------
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<br />DATE
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<br />- nECEIV-ED""BY----.--- --'---
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<br />RECEIPT NO_ ~,_\~_ DATE ~:l::~.,=l:DBY D_~-:_____~_~
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