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<br />
<br />flASCO COlJNTY, FLOf~IDA
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<br />.........,'..'..~~r~.'" "",.,..".,.................".,."'."..,.,.,-.
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<br />, .,...- c.,,'.~, .,....--..........,.,....,""'..,.........".,"-__ ......_...~,,~..,._........"", ...~y...".,_....,.....,__''''...,..... ...~....__..___~,'....__...."..,..............'--........,.,..,., _"""''-'"''''''''''
<br />
<br />Builder Name/Owner Name
<br />
<br />") 'J /
<br />. (~ ."f~.LU(:_.qtr.(~e (!-.!.~~.~~
<br />
<br />Permit No, .<:Je,)', :"['
<br />n at e Pe nnl t le.(j---'~:i-~; (:,-~ -t:-:- f2~'
<br />-.-- --.-......-.-----..---- -._~
<br />
<br />I :ontrol #
<br />
<br />.< '} " 1.0 ~ '! '.)'
<br />CotJllty rl8rl;811'Ju",)<j~~S:"~I::-qc:,'>QJ,Q_~C~,li'\_8:,"~q_:__,;.z.~_Q_ ~)U) "IV:
<br />Address/Location '(~/'j/L)..___l,~!~.. _ j)(:.:\_./!~,.(_.: _.
<br />Classificatlon/lype of Use ,.,-I/J\:,LI,/fc__._/(~; _7~:r~____
<br />
<br />._-'-.._.__.__.__.~._.._- - -, q" -.---.---.--.+---...
<br />
<br />TRANspcm IArlON IMPAGT FEE
<br />
<br />Hale:
<br />
<br />Sq Fl Unll::
<br />
<br />Exelllpt LJ Yes 1"4 No
<br />
<br />How Delermined
<br />
<br />ImpClct h~e All1ollntJ.l~'~?:A: ((L.
<br />
<br />Zone No. TAl:
<br />
<br />.--______n__"_.~.._ ___.__.
<br />
<br />scTin () r:Tf"j'PACT .FEE-."'''.~_.~ ,,, ..,......",.."'"'..".u._,.,..,,_....,..~..._'''' """''''''- ,,~"'".... .....'..'''.._.. ,_", ,.._.'....",.~,~.. _,......'.._.....,....',..,..,..
<br />
<br />Accuunt (056) Slrl~lle-Farnily IJetached Ilouse
<br />(05"1) Mobile Homs
<br />(U513) CHher Residential
<br />J'f3) CSl!lectioll Fee ,
<br />E)(etnpt Iv! Yes LJ No How Determined '.._____.______. _..__...._.._._,_._...,.
<br />
<br />AnlOltrlt
<br />
<br />$
<br />
<br />-.---..---....- .... ,,--- ----.,,----..
<br />
<br />.-,- -.-.- .-~-.__ "___U__'.'___.'__,,___
<br />
<br />PAR J{S"AN fj' r~ECREATI ON'FEE'- ..,...~._...~.,~..,.."'..'"_._-_.._,-~_....._..__.._.._..,_...~_..__......"..__,.._....~.
<br />LWld Account Land Credit Land Total
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<br />Hec188liun AceDllnt
<br />
<br />..-----.----. -- . -.--.-.----- ...-.----..
<br />
<br />. .1~El_(~reati on erel I i t
<br />
<br />r~e(;reationrolal
<br />
<br />Zune
<br />
<br />TOTAL AMOUI\JT
<br />
<br />..lli.__ _._
<br />
<br />.~...- '''-.--'---.-.-. --.-..
<br />
<br />~~~.~JnPt/rTYes r"J !\Jo
<br />
<br />How IJetermin811
<br />
<br />-._._......__.~-_..- ...._--'_.__..--~..~-_._-.. ~-
<br />
<br />Ii snA'RY' Fr?, if'
<br />I.and ACCUIlIll
<br />
<br />"'.,. .' .... '''' """"...~",.,...~, -.p.,' ......-""''''',.,~" - ".- ...._.rv-. ~\'-".,,,,,..,,..,.., "'ot,....,.L_.~.. ...-.......-..-...r;......'-..'- ~"~"'.""."~,"-_.'.--~,.......~..,...........,.,....,,.~.. ......"'...,...,.._..... ...,,~..--.......,.,..>'.,". ....&,.. "..,.'..... ....
<br />
<br />land Credit
<br />
<br />L:El.tJrt.Tptal,
<br />.-.. ------ ---::..-=--.-:-_-----
<br />---~----
<br />
<br />....~._... ....-..-----.- ...-......__..._-~._...~
<br />
<br />Facility AccOlJl1t
<br />
<br />-faeitlty"C,:edlt
<br />.-.'~--"-'-'~
<br />
<br />,... --.--.---....--.--...-.-.--
<br />
<br />Fanillty Total
<br />
<br />.---'.-
<br />
<br />. _._-~_.._--...._---~-~^~.
<br />
<br />F:xel1lpl/.II?e~ [] No
<br />
<br />How Dele/mined Total Amount
<br />
<br />-..-..-..-----..-....- .---- ---.---.-..---..... ..----------..
<br />
<br />....:;:::-"~.._,~,~. .....- ,.... -~'-"- '.. '", "' ...".,,-.-..,.,- ...." ..._.'.,-~.,"'~".-. ....._....-..__...'",~-...~----,." . ~.". .,~.._-."~". '~..,~_..._...,,' .._----,...~"......._..
<br />RESOURCE FF~E ERU
<br />TOTAL AMUUNT
<br />
<br />-", -.-- ..--....-.-- "- .__._.._---...._..~
<br />
<br />---..~- .-..--. .----.. ..--...--..----.-...-.-. -'..- _._ u_
<br />
<br />Prepared /3y
<br />
<br />...'____..... Checked By
<br />
<br />._~_...'".- . - ------...--.-.... --.....-----.-.-. ---....-..-". ..-.---------.-
<br />
<br />NO (;!:HTIFIGAfE OF OCCUPANCY WILL BL~ ISSlIED on FINAL. INSPECTION
<br />PEFU=ORMEU UNTIL THF. TOTAL AMOUNTS I.lSTED IlAVE
<br />BEEN PAID ANn
<br />J~E(a~IPTl:D FOR BY 1\ CENTRAL PERMITTIN(~ (WFlCE ()f PASCO COUNTY
<br />
<br />Acknowledgell1el1t hp,low does lint hl1ply acceptallce of co nClIIrf;l1lce, but simply receipt of A copy of tills form, placlnq
<br />tile building pelllllt owner on notice of tills assessment and tile condlt/ons of paYln8nt fur same,
<br />
<br />DATE
<br />
<br />-'--"- .---.-. ---_.~-_..'".
<br />
<br />nFCEIVED 8Y
<br />
<br />RECEIPT NO,
<br />
<br />DATE
<br />
<br />~~.- -"__'~'__n~.....__._
<br />
<br />BY
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<br />,---."' .".~ -~_.~ --.-..- -.---.---.---. .._.~...
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