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<br />
<br />I] A~; (; () <.: () lJ N wl"Y, I~' (." () r~ I [) 1\
<br />
<br />".Hh"_.l-'~'~, .'~ . J~.."'""""_,, ~~.," .
<br />
<br />"'....,...,...,.,,'~ ............,."....,+" 1'-'..'....,......"., ~o.' ';.."'"'' ".""" ,..., ,..,...... ~...~,,,..""~, ,". _<C,,,. ,_'._,. ...n..,-, ,"0.. _'''' ""'''',",",'"~'' ""'.. ,_ . _'. ~_'~.,....' ....cr_ ......"..,...,. ..........,,,,,,,,
<br />
<br />IJ811111t Nt), :J~ 1/
<br />I >ate Pen llllledj~ ~/c1'~<..J-~u
<br />B IIl1del 1'1" IlIefl h.yl1el N alll$'~"",.~<l~ ,l Qt'wfJJJti. C IIl1trol II .
<br />r: 01111 ty I' a"." I I "" ,3 'I . :;',fi: -:,2 /. l' (;;1 Q .- <,;.! rilXY P ,;1/8111>\1 Iv: C /_y. "",,(Ll~$"'$
<br />AddIEJSs/II)(;81IUII ,3 Z~u{) 4z :Z-/~~:~(J2'211. [2'1-<< :uuu_. ___/
<br />C;lassifl( :8t11 1I1/l'ype {Jf LJse (---:~~.)? /?(;zt:i&.u~2~7:1~
<br />
<br />THANSPOH IA110N IMPACT FI~E f~ale:
<br />[:?)(Hllllil II Yes \J~o Ilow t>etsl'lnlned
<br />/....
<br />i'J .-'
<br />1I11liEld Fee AlllOlll il :li !l::-.!:- >?..8)---:--~ lone I\)u,
<br />
<br />Sq H 11111t:
<br />
<br />TAi:
<br />
<br />'ijii ii6f)['iMP'j\r,;r.FEif....." ......"... ......-.~...._. ".... ""u'''_~,
<br />/\Cl all II 11 (O(3fi) Slllule..F arnily L>etauhed House
<br />(on'?) Mobile 11011\8
<br />(()f)!3) (Hher r~8sldellt1al
<br />j) 2:3) CC})le<:tlun Fee
<br />E)(8111pt 1Y1Y8s L II\Jo Ilow IJetennined
<br />/
<br />
<br />"~".~ ,~~ ,',' .....
<br />
<br />.,-.. ,.... .l._...
<br />
<br />AIIIOllllt $
<br />
<br />.2,'./)7
<br />...../l? /~
<br />
<br />'f) AfH<s Ar~ f)m~GREAW()trFEE'
<br />L811d /\CCOI1I1I Lalld Credit
<br />
<br />Land lolal
<br />
<br />Hel;1 Hellion /\(;CUllllt
<br />
<br />F<f'lCleatioll Credit
<br />
<br />necreatlull Total
<br />
<br />ZUI18
<br />
<br />TOTAL AMOl lilT
<br />
<br />'I'
<br />d
<br />
<br />EX8111L>1 II '-( es '-I t'lu
<br />
<br />Ilow Uetennlllsd
<br />
<br />.z::-. :::::.. ,~~,_, "".'.,1___.. '._ _."<0-,.,... 0..;,
<br />LIBRARY FFE
<br />Land 1\\ :culll II
<br />
<br />Lell 1(1 Credit
<br />
<br />Icmd ., utHI
<br />
<br />hwllll)! /\CCllllI It
<br />
<br />-.-':'- ,,'--:~
<br />
<br />Facility Credit
<br />
<br />Facility lotal
<br />
<br />F)(f3111pt .' '....1 Yes I I t.~() Ilow UeI81'1lIInedu.nu. ,.
<br />
<br />~(E,~~ij~~~,F;~7 ....C... --'--zy-:;;;;- ;;;-------...
<br />.IJJ//__un._..~. .,
<br />
<br />Total AlllOlIllt
<br />
<br />',',. '.." ...,. "" "" .........~..... -'. ~ ",....., "'''..", _...,,~._., .. o. ", ,., ,; .... ,_ ...~ ,....... ~'"."'" ,. .. ,_. .," ,_,"" ,,'
<br />
<br />Ef~l J
<br />
<br />" ~',.,. .. .,..," ." " """"'. u,.,. . .c..,., , ^. ". ", L'.", -.......'-.. '-'.' ',.. ,- ~ .., .~.,' ..__ ".' ~ ,.", ,,_, '._""'''' '""'" .'" .O-'U"'''.
<br />
<br />1'1 f'll lalwl Hy
<br />
<br />Checked f3y
<br />
<br />I~f) GI~lnIFIGA"'E or: OCCUPJ\NCY WILl. 81: ISSllI~l) on FINJ\L INSPP.CTION
<br />pi:m:'or~M~I) UNllL 'IIIE TOTAL AMOUNTS I.ISTf.:D HAV~
<br />BF.l~N PAil) ANn
<br />rm(:I::U'TI:ll FOR BY A Gt~NTRAL. PEHMITTING OFFICE OF PASCO COUNTY
<br />
<br />AckIIO\^llf.lduelnent bHlow dues lIot Iillply acceptance of COIH:1IIT81Ice, but simply lenelpt of a copy of II Iii;; fOIlIl, placlllO
<br />tlte h\lildlilll pelllllt owne, Oil IIollce of this assessment and the Gondlt/<)jJs of paYlllunt fOI S81ll8.
<br />
<br />~~ECEII)I I,ll},
<br />
<br />IlAII::
<br />
<br />. liE'GR i)h if- .r) .' .' .
<br />!J-jlf,~B. tlY ~Vl).C~l(Q-
<br />
<br />DAlE
<br />
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