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<br />
<br />CUIIIlty 1"J8I(;811'lo.
<br />
<br />~')etllllt Nt), . ----3f_<fL
<br />Date Pennltted
<br />
<br />~~~ -n (}--t- () Control if.
<br />--'---.....- .__._-----~_.. -. .---.---.------ ....------
<br />
<br />._---. ------ --------.--.,-- ..~-_.._....~-....__._,.._----- .... '.--- ----------------
<br />
<br />SubDiv:
<br />
<br />Li r ----{-4
<br />Address/Location _ --7-- ...-O-~--_~------=___._'2L'~_"___________"______________n._
<br />
<br />.--------.-..---..-- U --__""L__.___. .____.
<br />
<br />Classificath ll1/1ype of Use .--~0-+J'21~.._-_..__ .._n___,__._......____._.__ __ ____________.. ___.._
<br />
<br />
<br />TRAN8POR l'AlION IMPACT FEE Hale: ___._________ Sq Ft Unit: ______ _____________
<br />
<br />. --.---.--.------.----...- ._-
<br />
<br />Exeltlpt [I Yes I~o
<br />
<br />Ilow Determined
<br />
<br />------..--- _._.~..- --.- -- -- _... -~-- - ,- ----_......
<br />
<br />.---. ".-.-.__.. .--. ,- .----
<br />
<br />Ilnpact Fee Amount -l....._L,~t~____..____
<br />
<br />Zone No. TAZ:
<br />
<br />._~._----~-----_..._, ---.,...--.. . ..----...--. .-. -~-
<br />
<br />scfi6-6L-j'M p ACT'r: E'i~"-."'-'-''<='-''''~''''''-~'''"-'''''--'''--'-' -"-""- ...~._..~.._-,,- '._-~..."~_.,-.~....,,. _.......,.___"..... ..~~ '" ..._.'"~
<br />
<br />
<br />ACC;ullIlt (056) Sill~lle-Farnlly Detached Ilollse AI110unt $ ----..h'.J?~.:...___________h
<br />(05'1) Mobile Home ___.____..___ --...---...___.h______..__
<br />(U5n) Otl1er Residential _______._________.__ _..____..
<br />.tI23) C9J!;.eilon Fee .
<br />Exempt [_I Yes LfNo How Determined _______.__..___..______..__._____.___________.
<br />
<br />p ARR!fA~j5' HECREATIOiJ FEE ~_.".._._._--..--..---------~~.~-.~.--~.---.-_..___.__,
<br />Land Account L.and Credit Lam ..
<br />
<br />......, - '---'--- ---~-- ",--~
<br />
<br />
<br />---.---... ____. '-0". _.__~ _'~'__ ....___.
<br />
<br />Heclealiun ACCOllltt
<br />
<br />ZOlle
<br />
<br />
<br />-.-- -~--~_.~- ~--_.-.....-...-..__...-
<br />
<br />I~ecleatlon Total
<br />
<br />Exempt
<br />
<br />TOTAL AMOLJNT..!1i_______________ ___
<br />
<br />[OJ No
<br />
<br />How Determined
<br />
<br />I..iSRA'Ry'FFE ..........
<br />Land ACCulII1t
<br />
<br />. "---- ----...-.-.--- .-. .- ._~- - - "--. - ----- - ". ,__ _'_~'__n_ _._ __" .. ~_
<br />
<br />,-, '-~'" -,- '-. ....."........""""'.,... '-" 1 .,.,,-.....--~....-.~...,~'....-. .... '. """""""".-".',,-, ....,.,..~......~..., ~,...... ",... -_~'-'2"...,_\.""..~.-... ~"""'. _..,...".'....._. _."._...._
<br />
<br />.. "---.....,......'.......-,.~...._,~_<r_~_'u. .................
<br />
<br />Facility Accmlllt _______________ Facility Credit __n______________ Facility Total
<br />
<br />
<br />Land Total
<br />
<br />-- '--.---.- -.--.--..-----....
<br />
<br />
<br />Exempt
<br />
<br />[..I No
<br />
<br />--.----.- ------4_._..4
<br />
<br />How Determined Total AlllOlIllt
<br />
<br />-.---.---.-----..-.---- ..'---.- - --_.._._._. n.
<br />
<br />RES b tJRCEFE'j~..~-...-~---1....----." i',_ --..-...-..-.----~----.----"~R tj".--"--..---.-----....-......-,...~-~
<br />TOTAL AMOUNT .__.___ __'- Jl.'f._____________ _u______________________..,,_
<br />
<br />-.--.-- ...----......" _..~......_..._......- ...----.-, ... .,~..-- ...... ....-.-....--".-. _.._....."'..._.....--""-.....~, ...-.-, '-".,,---.- .."--_."......,,,". - "-- .-...- --....
<br />
<br />Prepared By __ .__._"__________________.._____ Checl<ed By
<br />
<br />__n. ,_ '_'___. __ ..'__.___._
<br />
<br />.. -..,,- -.--.__.~._4__._ __ ._....._.__
<br />
<br />NO CEHTIFIGA'TE OF OCCUPANCY WILL BE ISSUEn <'H~ FINAL INSPECnON
<br />PEHFORMEU UNTIL TI.IE: TOTAL AMOUNTS LISTED I-lAVE:
<br />BEEN PAID ANn
<br />
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