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<br />
<br />PASCO'COlJNTY, FLORIDA
<br />
<br />.............a"'~".,.,,,. ,. "'.......~.............".~" ,.....,- ,-., .'..-,.......".,.,..,.. ""'.....,-".".,.--..........~..."... ~~'.. .".......""..,..".~", __,~~'... ..'.T~'...,...,., ...,...,.~.....-._,_~_..". > .,~.-....,....,,,.,,....-....,....,-~..r..."~ "'....,,', , , 'l.''''''' _'~''-'~'''''.''
<br />
<br />Pennit I'lu,_:.:?" f1/_.___..,
<br />I late Pellnllled -F.r;JriJ!.r:
<br />Bllilder t'J8I1le/Owner !'-Jame -__2h~u.L~~lkJ,f{( ~.;}:.\~_1J,4 (~(rf{',~ #__ __.______ _____.__.
<br />
<br />COllllty Pateell'lo.
<br />
<br />SubDiv:
<br />
<br />Addr8ss/Loeallor I , 3/2l~1IL.. h 6~l'\."1.{.L .b.lv..i.' ___
<br />I'I _ \ r ~'. -1_ ~_
<br />Classific8t1onllype of Use_L.?6:vy\'J~.~".V..::--.v 'hJ__~\-~_ ,/a-:y-_LC _ _ .
<br />
<br />TF~^NSP(m. !AnON IMPACT FEE
<br />
<br />Hale:
<br />
<br />Sq Ft Unit:
<br />
<br />Exelllpl [1 Yes [h~
<br />
<br />Ilow De!enllined
<br />
<br />Impact Fee Amount _1.l2.;-7fLi~_!._o..____
<br />
<br />Lone No. TA?:
<br />
<br />scHf5of:TM P AGT' F E E"""-'."--' ...., ""'n_.,","~,_" ~"-''''-',~. ""-----"-'-"-' ,.,.,
<br />
<br />'-<:-""=~"'7......."~.."",.~....",, "...._...W'"....~, .....,.,......-"..,...__."~_ _".. ", ..'_...
<br />
<br />Accu\ JI1t
<br />
<br />I:xelllpl
<br />
<br />(050 )
<br />(Oul)
<br />( OIi/3 )
<br />(12:3)
<br />1"\ Yes
<br />
<br />Slngle-Farnlly Detached Ilouse
<br />Mohlle /'lom8
<br />Other Residential
<br />Collection Fee
<br />I] No l'low I)elennlned
<br />
<br />AnlOI.lIlt
<br />
<br />(\'
<br />,)
<br />
<br />PARl<ffA~if) TiEC REATION"Fe E ._.....m~.,_~_..._._._"____,_~____._.~..___ .- -_..~.-.._-_.._-,.~..
<br />Land Account Land Credit Land Total
<br />
<br />ReCIAr'lli!)ll Al;CfHlIlt
<br />
<br />nee
<br />
<br />
<br />R,eCle8tion lot81
<br />
<br />LUllS
<br />
<br />TOTAl. /\MUtH'IT
<br />
<br />'I'
<br />.,
<br />
<br />Exelnp!
<br />
<br />
<br />['J "'10
<br />
<br />How Uetermlned
<br />
<br />...J; _. -.,....,.- -' --... ~".. ,..... '. ..,,, ... """ "'"'~_"__' .",,, m.,.w,.,.... . __, .._...._"...""'''' "'''" .. ~,.,_._.. '... .... ,. "'.,~.,.. ""~,.,,,_, _~_..,~_. ._~.___._..... .. .__..
<br />LIBRARY FEE
<br />Land AccuI Ill! Land Credit
<br />
<br />
<br />Facility ACCOllllt ..
<br />
<br />Facility Cle
<br />
<br />Far~ility Total
<br />
<br />Exempt
<br />
<br />
<br />How Delennined
<br />
<br />Total Amollllt
<br />
<br />-
<br />h3~-'"
<br />I
<br />
<br />'~(~~~,t,j~~'~;'~~'~"~"~~~5rii'''pt;~..... -. ""-,."......--,., ,,' -",--...,~---.. ".. "'""'--"'ERrj""--"-~'~=.~:"_'_._~"~~=-~'=~~~-~~-~~=
<br />
<br />, ___ ._.~___ .._.'.__
<br />/
<br />
<br />......,~,.. -'.-","...,.... ---.-,. -_. '~..'-"'.>' .--, ""'~",'I,",,,, .~.' ...." ~,... ""......u..............~.....,........"";.';J I..",.."...,._"'~...~~~>..,'_ ~_.'~.-_...-___~.." co_,... "'~'M...." "u.'__''''''',''-'__~\. ,."..~....." ,.",._~... .-.......",..~ ~-<"~H".....- -.....,.~,..".. ".,.. ~.'O""'" '..~..,.. ",.,.. ..~. _~.,.'."..".,..~___
<br />
<br />Prepared By
<br />
<br />- 0 __......_'__~.._..__.._.______ _ ._____.~__..
<br />
<br />Checked By
<br />
<br />---- _... --.- ..._ __ 0-_.. _ __ ,__ __ __ _~.. ~_____ __,
<br />
<br />NO l:EIHIFIGATE OF OCCUPANCY WILl.. BI~ ISSUED on FINAL INSPf~CTION
<br />PEHFtHtMEU L1NTIL TIlE TOTAL AMOUNTS I.lSTEt) IIAVE
<br />BEEN PAID AND
<br />m:cr:IPTI~1J FOR BY 1\ CENTRAL PEHMITTINO OfrlGE OF PASCO COUNTY
<br />
<br />Acknowledgement below cines not hllply acceptance of concurrence, but simply lecelpt of f'l copy of tills fOlll1, placlnq
<br />tile building pel/nit ownel on notluJ oj tills assessment and tllA conditions of payment fur 8all1e,
<br />
<br />DATE
<br />RECEIP r No.11!10_~k_ UAI E:
<br />
<br />~)ft<j
<br />
<br />.------.. --------. --_..
<br />
<br />
<br />BY HJ:B~~__
<br />
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