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<br />PASCO COUNTY, FLORIDA
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<br />. .~".. '-"-"-"'".~"",,^,...,,, .,-. ".'-'--,~,"""",,, '''~'"'~-~"..".., .' ""'-'-~"""--"'" ',"'.. ot,,_ .".._'... ',."..,...._.. ,.~.".~
<br />
<br />,) .' , "
<br />Perflllt 1\10. , " ()//,(>
<br />- --.-----........ -0.
<br />r J8te Pel milled ._.-,IL_.j~.:(V-
<br />81111der Nallle/Owner Nallle -~:'c,\" "\&~_MI:'~I'}r"~' "_~_~~ ~. Control #~.__~_~~
<br />C;OlJl lty Palcel No.:3l.j..._~![~;;'L~ 09,~~-" ~?:~o --3.~;-:;', Subl )Iv: ,Q ilL.
<br />Add res s/Lola tlllnf L 'C' 1/ ; (Ic'l Be, l) ,) (
<br />Clasf3ific;:jt!ollllype of Use fH ".., ~.) ( \s -._..ji})~ \"~' '___
<br />
<br />TRANsporHATION IMPACT FEE
<br />E)(ell'pt [1 Yes I~JNo
<br />
<br />Rate:
<br />
<br />Sq Ft lIlllt:
<br />
<br />Ilow [letermlned
<br />
<br />Impact Fee Amount --~"--,,L~,~:S
<br />
<br />, or:'
<br />
<br />~---._- ._-"._-~..._--~-.,-,,---, - . --.-..---- -.-'-.-.--..--.--- . '--', .---'-- '..----.
<br />
<br />Zone No.
<br />
<br />'sCn()CirrMPAGT 'F'EE'''-'-'-'''- "'." ....,.,. "'" ,'.,,,.--.-_._,w," _A>_._....",',...., ,_,
<br />Accuul1t (05G) Sinqle..Fatnlly 1J(~tached HOl/se AntOl/tit
<br />(DGl) Mobile Home
<br />(mil3) Other f'"<esldenlial
<br />JI2:3) C~llectlon Fee
<br />Exempt r~1 Yes L J No How Uetennined_____ _.'._______.
<br />
<br />------------.....--.-....-
<br />
<br />TAZ:
<br />
<br />'''~.-'''''''''';'~,"'" ....,;.,........."',4....~_,..,.,. ""'''~""'''''''._,.... '.'
<br />
<br />$
<br />
<br />" -."........ -. --._.... -~..
<br />
<br />u ... ___.___. ___.. ___....__ _..._.._._.
<br />
<br />PARi<s7\Hfi -R.ECREATf6NFEE....'.'.._'~...,_. ._'"--_."-._-_.>O~"..._._~__ .'.'.w.."'....,_.___...._. _.'....__...___..__.
<br />L1:lIld AceOlllll Land Credit Land Total
<br />
<br />. .-...--.-.....-..... ---_.. -'-'--~- ~---._---.
<br />
<br />'. ---..-.----..--.
<br />
<br />.--..----.... _"h.__, ~
<br />
<br />neCIAr:'ltlutl/\C:C(lllltl
<br />
<br />necreation credit
<br />
<br />l~eCleati(Jn Total
<br />
<br />l< It 18
<br />
<br />Exempt r I Yes [J No
<br />
<br />TOTAL AMOUNT ,l..,.. _"'_'_,
<br />
<br />110w Deterrnlned
<br />
<br />IIBRA'i~,Vf.F. E'''........,."........, '>"-'"' ...--..---, ".,. ...,....,_...._-'~...."--_.,,~_-.,_..._'~_._._..~.....__._...___...'_'''___...__.,._
<br />
<br />
<br />LatHJ /\(;CUI H It Land Credit_.__ Land Total
<br />
<br />_._.-._._-----~_._---._--_._...__._._-------_.._-_......--..--------.-.'"
<br />
<br />Facility ACc:ollllt
<br />
<br />._"'._-~-------~._.- ...-----.-.
<br />
<br />Facility C;reeJit
<br />
<br />.--. .-. --...----__.n._____..__..___.._
<br />
<br />Exelllpt r -,I Yes [] Nfl
<br />
<br />... --. "-'-'-'--. '.-- - ----
<br />
<br />Facility Total
<br />
<br />--'---"--'--.- .""'..,., ---.._---_.~~
<br />
<br />..-....~,,-. .... ..~'<....._--.~. "'''' '''-'-'"~~.,. """,, ".....~... -"-'.,._"..~., "'''r~..""..._"". '",,_' "_~_"_,,"',,_, ...."...._ "___.''''''__.,_.._.."~,......,~~___,,.._"...,..____
<br />
<br />How Delenllined Tolal Amount
<br />
<br />..--~-,----. ----.....----"..-~...- "--"__0_...__ _.. . .._.___.~.
<br />
<br />RESotJrWE FEE
<br />TOTAL. AMOUNT
<br />
<br />ERU
<br />
<br />.--..- .-.. -.-. -........ "'__~'.n_._ _ ....._____._....__._..
<br />
<br />.---.---. --'.- '--.- -".~- _._...__._--~..
<br />
<br />'_'~""''''''''''''''.-..,-.......-.,.,.,,,,....,,
<br />
<br />Prepared By
<br />
<br />.. "--"'-'---....-. ,. - .--.-..----
<br />
<br />Checl<ed By
<br />
<br />--.---.- -...--..----..--
<br />
<br />NO CI~lnIFIGArE OF OCCUPANCY WILL 81: ISSUED on 1~IN^t. 'NBPI~GII()N
<br />PEru:OJ~MEU UNTIL TilE TOTAL AMOUNTS LISTED IIAVE
<br />BEEN PAID AND
<br />I~EGEIPTE[) FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY
<br />
<br />Acknowledgement helow does lIot hnply acceptance of concurrellce, but simply lenelpt of a copy of this form, placlnU
<br />the IllJlltllng pennlt ownel ollnollce of this assessment and the conditions of payment for same.
<br />
<br />DAIT=
<br />
<br />'--'~n_ .._..__.._._._ '___"__"""_
<br />
<br />Pr:CEIVED BY
<br />
<br />HECEII'T r'Jo.
<br />
<br />DAlE
<br />
<br />BY
<br />
<br />... --. . ..---.--....... -_..-.~--..m~..--__._.___....__..n.._.._
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