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<br />
<br />,:)AS(;() (;C)\JNl'Y, FL.()r:~II)A
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<br />.' ,_._,,~. ....,".,"n..... ..',' -"-H.....'.., .". ".'_""--'.'.L,_ '~"".,_....".'''""".,..,,. '
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<br />'V. _ ....~ ""''''''.''j ........ , .~. _"'..c', ,", ,.' ,_ ,.,
<br />
<br />,",~. ...... ,.~~~. p,.., "",...,' ..' ," ", ".'. ~ .....'"
<br />
<br />Peltlll! 1'.10,
<br />IJal8 Penllll!ed
<br />
<br />BIIII> I ar He Illa/' ,>wller Name ~.t:ht,-,jl~!#.:"~ ~~._ . . ~ Gnr~t;olll
<br />-:1." 0 '1 'A
<br />COlli tfy Pal'(;81Ilo, J /1- -~.~S-: :,~ L-=-Q_QLQ~_Q_tl ~t't~ "311I>DI\I:
<br />
<br />Addl88S/101 :<:111011 J1 ,.;/if; NR.?.J~)2-:\. /1 ~f:_
<br />
<br />C;lassiflci'lfloll/lype !)ILJsellJ'Oi;~<--.~_ ~2-1-~~._
<br />
<br />,"1 --7. f
<br />. '-> "::'
<br />. .~:..::...'/. ....__._u,
<br />1/ - olt./ -1'3
<br />. p' ....l_._.__.... -.,(~... ,'__,,_. _"'__
<br />
<br />lR/\NSPOH IAltON IMPACT Fl:E
<br />
<br />F~ate:
<br />
<br />Sq n Utilt:
<br />
<br />F:X81111 It I I YAS !iJ'(.lo
<br />
<br />Ilow Determined
<br />
<br />II llpad h''H3 AIIIO! IIi! f~j.(:; J.- J(
<br />I
<br />
<br />10l\e 1\lu.
<br />
<br />,I'AI
<br />
<br />'ij(':n6()CiMfiACT'FRi.r"'''-~'h''".''"'. ....~ '".,....,... .
<br />AC;r;UIIIlI (rJljfi) Slllule..Falnlly Ilelaclled I louse 1\IIIOlltll ~I;
<br />(1)1) l) Mobile f IOlllEj
<br />(mill) (libel' r~esldel1l1al
<br />(I ;d:3) C;ollec:1I1J1l Fee
<br />E)(elllpt I ~'?es L] I\Jo How Ueterrnltled____._
<br />
<br />..PAf~l<sANf)t~f:6REATi()trFE'Ef . ......', ",."'"
<br />Lc.ll\d /\I;COI II II I ,alld Credit
<br />
<br />- .., '~_>J'''_'_'' . ..d,u." .."~..,, . _' _.~.... '''_., ,
<br />
<br />land Tot81
<br />
<br />nel;j AHlioll /\(;(;UIIIII
<br />
<br />'<.ecreatlfifi (;!erllt necleaUull Total
<br />
<br />LUlie
<br />
<br />rOTA I. AMOUI'll .1.
<br />
<br />g~u;ljnpr I l'les I.] I'Ju
<br />
<br />'Lis R AiiY i~ F if
<br />L.f:Hld /\CCOIII il
<br />
<br />. I low Ileterrnlnsd
<br />
<br />" ......, ~-"'" . '..'~.., "-''',. . .... ',,',"'''.,' -- .'.' .-,
<br />
<br />I 81HI Cledlt -.....".,
<br />
<br />""". .--
<br />
<br />181111 lotHI
<br />
<br />FadlllV!\(;(:(l11l11
<br />
<br />
<br />. _ Facility Credit
<br />
<br />. Facility Total
<br />
<br />F )(8Wpl.' . I' Yes
<br />
<br />jl\ju
<br />
<br />How Uetellllilled
<br />
<br />Tota11\1lI01l11t.
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<br />~,~~ZU~Z~)If;;-;~ ... .Tiil)-f1j-ZI!~/'-_."~ .-.~. .~ ".~'Ei1U.'~.~='......~'::..::~"~==
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<br />. , '~'''''-'~ '..... ~... '. .. ~"J.. .~.., ....." '.... r." "...,~... ,IL ,'..~_ -'-~.,.". ..~A..;'-"~,... '~"., .,_.. ~""""""".. _~,,_,_ '_'.-0-1.......',' '" _.' ,_.
<br />
<br />"'" '" -, ... '- ~ 'to. .. ...~..,~...',. "''''''4'.'. '_,". "'___
<br />
<br />1)/81 )8lerl Hy
<br />
<br />Checked By
<br />
<br />NO CF.RTlFIGAlE Ol~ OCCUPj\NGY WILL 81: ISSUEI) on FINJ\L INSPI::GllON
<br />PEIU:CJHIVIl-=1U UNllL lJ IE lorAL AMOUNTS USIl::D HAVE:
<br />BF.~N PJ\ID AND
<br />l~f:CI~IPlIEn FOR BY A (a:NTI~AL. Pcl~MITTINO OI~FICE (JF PASCO COUNTY
<br />
<br />Ackl \1 Iwledyel nent bHlow does lIolllllply al~cept8IiCE1 of COliclllrelice, hut simply 18cslpl of !:1 copy of Ihls fOlIn, plac:lll(J
<br />tin:! hlllldltlU pt3l1nll owner on notlc8 of this asseSSlllsnt alld the GondlllollR of paYll18nt fl)l RAllle.
<br />
<br />m'::CI:IPI !K),
<br />
<br />DAlE
<br />
<br />IJ;qiJ,
<br />
<br />iiE(;$;EI~~)[12()
<br />IlV {"JflLz/? M~-
<br />
<br />
<br />"
<br />
<br />DATE
<br />
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