|
<br />
<br />PASC() COtJNTY, FLORIDA
<br />
<br />. ...,."~..~..,....."~...",.....,",,..t.....,,..,,...,,_,"-..",,,,,~,,,,,,,,,,-;,,,_,,,......."''''''...,...._.......'''"...t.......,.".,.,.-,;I''"=~.,......_...,,;~.,... "_"_"'..,..""""_"..,.,..~"..,,,.~_ ..;,...._.r~' .....,"'*'........,..",...,..v, .. >..,.....,,,.~,, ~" ~,:...._..,~"'_
<br />
<br />Permit No.
<br />Date Pennilled
<br />
<br />- ~
<br />") .., f" . /
<br />. l _ _
<br />~-h~"~?~~..:~i~:Z=
<br />
<br />Builder I'JElll1e/Owner Name (..<!.~1 i (, 1.- /!f.) I" .') \
<br />CIlllllly Pa,,,.lllo. ...' 'I ...._;~~J,;,~~~I.,~,:...;~L
<br />
<br />Control #
<br />
<br />~_..~ "'--'--'-"--' -"-."""" '_h__.... '_"W.._~. .
<br />
<br />SubUiv:
<br />
<br />Addl8ss/LucaUoll .. ___.:' L) (-J C_-_(L:_LU_J L~....\'____
<br />
<br />-....--.-,.....-.. ._, -_.._~.__..--..~,. ~'-'---. ."..--.-.
<br />
<br />Classlficatloll/lype of Use__ IL\,fJ<Ld,c,:_.{L~).Gc'::'...
<br />
<br />_._.__n______.....__._..___~__.._.. _.._____.,,___.__. .., ____.. ____~~.._. .._.____ ~_.,___,_____~
<br />
<br />.n~^NSpon IATION IMPACT FEE
<br />
<br />. - . ----_. ..____~. '_'m_ _._"'_~.. ..._.__._..~~____..____~____
<br />
<br />F~ate:
<br />
<br />8<1 Ft Unit:
<br />
<br />Exempt [I Yes [] 1\10
<br />
<br />Ilow Deterrnlned
<br />
<br />. -"~-_."-,._..------..-",._--..- --.---
<br />
<br />Impact Fee Amount . $ (,) 8 (l<
<br />- - ._".... ...... -r--"'-'--'--,--,~,,---,-,-
<br />
<br />Zone No.
<br />
<br />TAl:
<br />
<br />"s61TGc.iLTMPAG'T FEE".."..-............'" .~"n'"~".,'.."c,~ '.'" '''"'0-' ~~'."n...~.._.'n.n"'.~,,"_
<br />
<br />,-" r..":_~""'~"-~.,,...~,.,,' '-".' ~'_;"'" .-""."r_""-....."....,._
<br />
<br />Account
<br />
<br />(056)
<br />(051)
<br />(OfiB)
<br />(12:3)
<br />I....~, Yes
<br />
<br />Sint1Ie.-Farnily [)etacl1ed Ilouse
<br />Mohlle I--Iome
<br />Other Residential
<br />Collection Fee
<br />[] No Ilow Detennined
<br />
<br />Atnount m
<br />
<br />.._--~-- -- .-,"., ,. - ...,..,..,,-------..-. .-..
<br />
<br />."'-'-~". -~. - ~...- -.-.-.----.--.......
<br />
<br />Exempt
<br />
<br />PArH<s)\N [)RECREATioN' F Eff"...'.~~'-.~_..,-~'"'..-""..,~._~_..."'._._'..m_'_n".". ...~.'~,....c"_.._.__..._...,,........._._.._.._.~_
<br />Lalld Account I..and C;redit Land Total
<br />
<br />.-----....--. --.-.-.~...~._."_._.." -'- ....,....-...-..- . _.~_.__".~n._ _________~.._
<br />
<br />r~ecl (3811011 !\CCCHJllt
<br />
<br />_.__._._.--._._~--. ..-. ~+_._---
<br />
<br />I ~ecreatiofi f:reclit
<br />
<br />r~ecreatlon Total
<br />
<br />ZUlle
<br />
<br />TUTAL AMOUNT
<br />
<br />-~-_.. ---
<br />
<br />Exelllpt II Y 8R '-J No
<br />
<br />Ilow Detern lined
<br />
<br />I_.....,.~:;..:.,~.,"'""._,-" ...... .."', .~~...,~ ,.~."",
<br />l.IBRARY FEE
<br />Land Accrllllil.
<br />
<br />~._.._.__._-_....~.__.._--. .. '--'-'-""-- _._-.- ..,.. --'--_'~_'.._,--... ...--- '_'__.,.,.~
<br />
<br />,..... ~-~.,.,..._..~""......~-,.."..........'" ',--......~.....,...""..,, "'."".' .. .. '.~ '~'''''''''.'
<br />
<br />LClI HI Credit
<br />
<br />-""~'----- _. -, ----~- ...----~.__. ,-.
<br />
<br />Land Total
<br />
<br />Facility ACCUllllt
<br />
<br />r=acility Credit
<br />
<br />...'" ...___ ___h_____. '~_...__._..." ,.__..__
<br />
<br />Facility Total
<br />
<br />Exempt [J Yes [) No
<br />
<br />. -......---.-.. .----- .. - -..---- -,~-
<br />
<br />.-0'...----,--" .-..- ...-. '-'_~"W-" .-., .. -....--.." ~._w, -'.......,"~-..-".."' -__"~__-.."-"'"~"._..."="_._..__-~ '_'_a."__.., ,__...._ '--"~-~"___or." __~,.~~~'"... .,_"~.".__..__...._,,__._____..
<br />RESOlmCE FEE ERU
<br />TOIAI. AMOUNT
<br />
<br />How DeterHlined Total Amount
<br />
<br />.-. '-~------'__""_n_ . __,_,.._.. ____....... '._'._. _.. '_~'____._
<br />
<br />---"-""-' ,.,.,-. -- ....- -. - .._....-,-~.._._--..._.._"..- '--".--.-" -'--.
<br />
<br />--.- --'''- '._'--,- "-."-, .-.--._~"..._~_..,.-.. ..----..-
<br />
<br />."".,...,." .,....., ~. .-.....~J.', .,.,. _".' ..~.. ",,",,.. " _, ".,
<br />
<br />"""'''-'K'' 0'.0.><-"""""". -r., ......._r-...,..,.."',.,...,..." CO'",,'' ""'..,--";.,.."r",.._"""."",,,.._,.~, ~". ...,."'.,..~.".."...., ~ '_''''- ~ "'""....~,.,.~c"...........=""''-~
<br />
<br />.,."".:""'-......,.,...,..-..,.""''''-'''''''''''''''''21><1_......, ""',.....,,_"',..-=..... ........~_
<br />
<br />[.lrerlarecl By
<br />
<br />._h --.- ----_____u__________ Checked By
<br />
<br />-- .-~--.. ''''-'-.'' --...~._-----.-~-- --"'- -------- '0__-. .... _'_0
<br />
<br />NO t:p.ln'IFIGAT~ 0\: OCCUPANCY WILt. Bl:: ISSllED OH F/NI\L INSPECTION
<br />PEHF(mMEU UNTIL THE TOTAL AMOUNTS LISTED HAVE
<br />BEEN PAID AND
<br />HEGEIPTI:() FOR BY A CENTRAL PERMITTING Or:PIGE C)F PASCO COUNTY
<br />
<br />AckllowledoemfJn! below does lIot Imply acceptance of COnClltlenC8, bllt simply receipt of a mpy of this form, placlllrJ
<br />tl1elJulldlng penl1lt owner on notice of tllis assessment and the conditions of paymenl for same.
<br />
<br />-'.----.___..._..0........" "'_.....
<br />
<br />DATE
<br />
<br />-.---.----.,- ----. -------
<br />
<br />nECEIVED BY
<br />
<br />FU:C:EIPT NO.
<br />
<br />---.----..-.....-. .---..--._-~_.-...
<br />
<br />D/\TE BY
<br />
<br />-~_._.--_.~-_..-.--. --.-----,..--______ 'h_...
<br />
|