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<br />
<br />PASCO COlJNTY, FLORIDA
<br />
<br />t....~........'''' ,...,J....,.......-.......-..-.......nc--...,..,.". ."""'....."'..."..,-,-.._"",............'~-....,.....,......-."~,---... """""""''''"''~~,,......."',,. .....,.., "'.'........ _'":-,~. .,..,.......'""".,.", ~.......,..-.~.. _.~,..,,,............ .'....~.., ".."""l'n..t>...... ~........."..,
<br />
<br />~') 41 /7'7
<br />Perrnlt I\ll).__._.:.:~~,./. / __._____.
<br />Date Permitted ---7.:'~':'.="~~..:_".L~
<br />
<br />Builder ('Jallle/Owner Narne ._~~~:I~f':Le_j)~~(,<Z(IL~.,_.._ Control # '___'__.......
<br />
<br />C<HlIlly l)alc;81 ~Jo.
<br />
<br />,5';-/ :.'.';'; s '~)/"~'~!(!_" t:~/L('-i~:!..~'~;}~'(. SubDlv:
<br />
<br />Addle8s/Locaficlt I ~j '/~:/).) <~/!y- _/_L~~~.\..._<(~~~.'..__._...__ .____.. '-.. .n..____..,
<br />Classlflcatloll/lype of Use.. 6IL)kJd.C_.l0'lL.\I__ __.__.___ .._n.___~_._....___.___..__, _...._____._
<br />
<br />THANspon rATION IMPACT FEE
<br />
<br />Hate:
<br />
<br />_. --. ,.- -..--.-.----------.... ..,.--
<br />
<br />Sq Ft Unit:
<br />
<br />Exempl
<br />
<br />[I Yes '''+No
<br />
<br />I low Detennlned
<br />
<br />1"'PEwt Fee AIl1()untl..{_~!i~'.~:..
<br />
<br />.-.--.-------..--- .._---...~-~..-._....- '. .----...--.---..--..--. -.-. "'-'-
<br />
<br />Zone No,
<br />
<br />s ci"i{jf)L~'I MPAC'T 'FE'["-'''- ._--". .'.... .~...-,.''''',.",... ..... ...._,,-._~'... ,....~'.."'..-..~._, ....."...''"-_.,_, ..v.,__,~___..... ......',..... _~....,_."..
<br />
<br />-.. "'-'-"'-'-~_.... --~_._-._....- '--~----'----",-
<br />
<br />TAZ:
<br />
<br />Account
<br />
<br />(056)
<br />(051)
<br />(050)
<br />{'I 2 3)
<br />!l],Ves
<br />
<br />Slnqle-Farnlly Uetached I'louse
<br />Mobile Horne
<br />Other Residential
<br />Collection Fee
<br />GrrzrQ Ilow Determined
<br />
<br />Arnount
<br />
<br />$
<br />
<br />------.. '-'... '--"-'''."-'~'---_._.-. -- '~'--"-" -....--.-...--.
<br />
<br />-'-~_.. -"""-'-.--... -----.-.---.....-
<br />
<br />'-.- --_.-. -.-.--....----...-.---..---.-
<br />
<br />E)(empt
<br />
<br />-.------..----.-- -.--~..__..h_.
<br />
<br />- -. --._~"...~.._.-._~~_...-. _. _. '-. --"-- -...
<br />
<br />PAffi(s'AHfj'RECREJrfION FEE' ....,-_._..,_...._.__._.._._""-_.....~._--_._-_..._...~. "m...~_.__..~_.._".
<br />LAI Hi I\Ccollnt L.and Credit '_._._._... Land TO.!gL.
<br />
<br />necle8fiun ACCOl" 1t
<br />
<br />--...-----..-.-......- .....-...-...--....
<br />
<br />"-'-'''--_.'''''__n...__..._ .._
<br />
<br />n~.cre8t1ofi'Credit
<br />
<br />Hecrealion Total
<br />
<br />ZUlle
<br />
<br />----.-..-- ._-._".... -- ---. '---"-"-.'
<br />
<br />TOTAL AMOUNTL___H....._______.
<br />
<br />EXelllpt [J Yes I'] No
<br />
<br />Ilow Determined
<br />
<br />IiBRARy.FEE........ ""
<br />Lallel I\CCOlllll
<br />
<br />.----~_.--.. .---.---- .....- ...---.-____ __'__m_.._._ _.___~__.~.._..._. '_"._. __'_
<br />
<br />.." .,. ." ".".~.~. -""'n'..",-,-_, .." -~. '. ..- "-"~"''''~'~'",''~'' ._"..,,.,..,.......~.._ ,..." ,.._..,.,,, -."'e......... .. ...."...,..".,......,' "'-~_'~. "'" ~. ..."..,,0>.,..... '.C",. ~ ..'.....".".....1 .._.. .__"_~,~'..._....,,.. '~11 . ". ".,'"-,--",,,
<br />
<br />Land Cledit____._-===-__=::-,~_=__:_.. I 811d '1 ntal
<br />
<br />Facility AC(;(JlJllt
<br />
<br />,.-
<br />
<br />---..- _._----.._-_.._----~--".
<br />
<br />--"
<br />
<br />Exempt LJ.Yes/TJ No
<br />
<br />.J.~dnfY(:;redlt
<br />-- ...~_... ....--.-...-...- '_..:.;,,_r.:'
<br />
<br />. .-..--------+----.--.---. -.~.._,
<br />
<br />Facility Total
<br />
<br />.. ...~._--..--"..__.. ----..-. ._--_.-.~
<br />
<br />._.._~..; m_.,_"... .._.__""'''' '~"......"....", ........__ '~__,..___. _..'.,,_,__. '''.._....._..____,._"'"...__..,_._..~,~.__.._.,_..._. .....__.._~_",_......._......'__
<br />.,RESOURCE FEE ERU
<br />TOTAl.. Afv1C)UNT
<br />
<br />How Detenllined Total AnlOllnt
<br />
<br />------_._.--..._~.... .-~_.._~ -..-.------... --'-''''..--. ._. ----_._-~.
<br />
<br />..---. - ---..-,,- .. - '--'--.--,,_ __ __ "U. '_._.._._. . __ _____
<br />
<br />..- .- _._...~~..-.._.._.--...-....--._._.~.
<br />
<br />.,...,.. " ,,... "'-N", ~_,., .
<br />
<br />Pmpamd Hy
<br />
<br />...'........, ,',....,...".' ".. ...~.,-','" -..., ....', .....,,',,",........, ....,.......'.........,..'.. "'" ..... ,,-". ......w..,_...~.. .~"".... _" ".......,..... ...."...,'......",.., .'.,,'.......'.
<br />
<br />_ ~_._..._. Checked By
<br />
<br />..".- . ~-------..~__ ..__ __n___..__.. .__ _ ____
<br />
<br />NO CErrnFIGAlE OF OGCUPANGY WIL.L 81: ISSUED OR FINAL INSPF.GTlON
<br />PEUr:ORMED UNTIl. THE TOTAL AMOUNTS LISTED HAVE
<br />BEEN PAID ANn
<br />I~EGF:IPn:n FOH BY ^ CENTRAL PERMITTING OFFICE OF PASCO COUNTY
<br />
<br />Ackllo'lvledgAl1I8l1t Ilelow does lint hllply acceplclllce of concurrence, but simply receipt of a copy of this form, placing
<br />Hw Ilulldlllg permit owner 011 no lice of tills 8SSeSSI11ent and tile conditions of payment for same.
<br />
<br />'h___._.___."__.___. ....~...."
<br />
<br />DATE
<br />
<br />._~_..._-_._- ...------..--.
<br />
<br />nECEIVEI) BY
<br />
<br />---- -_..~_..._....._-......_-_. ----....
<br />
<br />1',ECElfJ r NC),
<br />
<br />. -------.----.-.. .- ----... .--..-...-......
<br />
<br />DATE:
<br />
<br />._n.....___..._._..______.._ _
<br />
<br />BY
<br />
<br />- ---..-.-----.--- --".- ...'"._---_.__._~._-
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