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<br />I:) A ("\ (~. (''''''') (" (')" l J N "J"V I';~'l () 1::)11) A
<br />,) ".t '" ,,". , "',," '" , " ,
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<br />"."."...,..~,.,., -,~, ,~""'''''J"",,,''~'''-A'' .'-' , '......_,"..'~,., '."',,"-,,_ '''''"'~~''''''.'~''''''4'' .;-c.."........... . no.', ....._.\,..,.,......,.,._'-..... '" "k'..'....,,,.J.,., h.."" p..., .~ "'.
<br />
<br />, ......'0.._.........,.,... "_ ~"""'"".~.,."..'.,, ."".,~,,,,.,,,,
<br />
<br />Pelllllt r\lD, :< .55' '7
<br />Date Pennllled ,Jt?:,~qJ',:':Lh__
<br />
<br />Blinder 1'lallle/Owl1er Name ~~.-^':'LdL.I(Yu:?fClr,._ ,_.. C,,"trol #
<br />.'L" 'II
<br />(:Ollllfy 1)81(;811 J(),.34 -~,s--- .;:{ L:,_a(u('):~q;;1.ji:qC) ,.c hullUlv:
<br />
<br />A( idI8Ss/l()( :r:it!OII . ,31Z3.l),.:)." ,j'V..Q~~CJ.~?t)x.s::~_,___.
<br />
<br />CIEl8siflc:811ollll'yps ()I' Use ,_ n'__
<br />
<br />"-..".. ____.._ '_M' .__.._____._ .' .__~_.__~..__..._ ___.
<br />
<br />TFV\N8POHI'AlIUN IMPACT J~EE
<br />
<br />Hale: Sq Ft Ut i1t:
<br />
<br />E:x8111pl I I Yes IJA'lt')
<br />
<br />Ilow Oelen nlned
<br />
<br />Il11l'nr:l h:m /\IIIOlllll ~t
<br />
<br />. /'~ ('"" (7 (~t)
<br />;.,)() () .
<br />'-/_., ,
<br />
<br />lrllls Nu,
<br />
<br />,"A!:
<br />
<br />'~mi i <1f)L-IrIl!f.'AC fFEE'"'' ".~",..... ".,'.. -.. ~" . "'"
<br />
<br />AC(;(J1 II II
<br />
<br />1::)(8111\)\
<br />
<br />(05fl)
<br />(Ill')/)
<br />(()f51) )
<br />Cl /}'j
<br />I t\{")/ e s
<br />
<br />SlilUle..Farnlly Detached 110\188
<br />Mobile Ilul11e
<br />Other F<esldel Itlal
<br />Collection Fee
<br />'--']1\10 Ilow Uetennlned
<br />
<br />Amount
<br />
<br />~H
<br />
<br />'PAR l<sA'N f) r~eCREATi()tTFEEr"
<br />1.81 It.l/\( ;C:Ollllt I.and Credit
<br />---
<br />
<br />Land Tut81
<br />
<br />F~e(;1 (-'l"Illull 1\I;COl lilt
<br />
<br />r<ec:reatlon (;redlt
<br />
<br />I<ecreat!on Total
<br />
<br />ZOlle
<br />
<br />,..-/
<br />..--.---:."':~.- .
<br />....--.'
<br />-----
<br />----~,..-
<br />~
<br />,,/-//
<br />E: XGJJJftt/ I I '/8S II t'lu
<br />
<br />TOTAL AMOUNT
<br />
<br />l,
<br />
<br />llow r >etermllled
<br />
<br />Lif3RAhV h::if
<br />Lalli! /\1;(:(1\1111
<br />
<br />. "-,, "',' "',,. ...... -' " . .. ",.'~,.~ .:-"......-.-.. -' ,.' .-.~,"
<br />
<br />LHIHI C;l8dit
<br />
<br />I.and lotHI
<br />
<br />Ff:1dllly /\(;C;()lllll __<::-,-:', ..,,__ ,
<br />/~.
<br />E)(8IjJPl..-" 1.1 Yes 1.1 t\jo
<br />.~r~
<br />
<br />Facility Credit
<br />
<br />Fanlllty lotal
<br />
<br />Ilow Uelernlltled
<br />
<br />Total Amoullt
<br />
<br />.-----.
<br />
<br />~(~~~iJ~~~lr;~~(Ji~t):~j.~Zt,.-..,.... '...-....
<br />
<br />..... ,". ".".,"" ~',"" "'-'-."-, ~~,...
<br />
<br />F:RU
<br />
<br />,_...... . '''h."", ~......" "';', ,'..., ".~.-..".
<br />
<br />Pml181ArI Hy
<br />
<br />"".. ~ - .,-< ....'. . ....,.-.".,' ._d_'.... ~,-, .,. ,,~. ~'... -'.~...,--~"...". "'--- '....... .",'. '."., .~ _'__'~"""'''''.. ...-',.,~.. .... " ,"" '"'~'_', ~.... ~,... J' ',' ." .",..". I. _, ."~ __,''". ,.....,.......... ~.~....._ _. '_" ..,... , '''.- ~ __._"".",_. ~,..,.....
<br />
<br />Checked By
<br />
<br />.- --.- ..~.__...._-_.---._-_.--.._~--._._-
<br />
<br />NO CEHTIFIGATE or: OGCUl'ANCV WILL 61: ISSUED on FINJ\!.. INfWP.GTION
<br />Pl:IU:OHIVlEU UNTIL TilE TOTAL AMOlJNlS L1STl::D HAVE
<br />BE~N PJ~I() ANlJ
<br />rH:Cl:IPTI~U t::un BY A CENTRAl PEI~MITTIN(; Ol:::PICE OF PASCO COUNTY
<br />
<br />Acl(lII I\VIBdWliIlent bHlow does 1I0t Illlply acr.eptance of concurrence, but sllllply rer:elpl of f:l I;OPV of thlR fOllll, placlnu
<br />the htllldlnu pellllll owns, Oil Iwlles of this asseSSlllent alld tile Gondltlulls of paYll1811t fIll sanle,
<br />
<br />r~H~r:lfll 1-10,
<br />
<br />DAII:
<br />
<br />?~'"
<br />j)., e f1V
<br />"- ". "..h..
<br />
<br />Ifltl;~~ 1)a-
<br />
<br />
<br />
<br />~ .I ..
<br />
<br />DATE
<br />
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