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<br />
<br />,:)ASC() COlJNTY, FLO'~IDA
<br />
<br />.~..,.."._,,,....,,. .'" ',"" . ..r'....'~.,...,......_.... ,.., '-""~' ""'''''''''''"'''-__'--' .......c-~",- .......-,.".~..'"'_,....,. .,,.,.-....,.~, ,.,. .,..,.."..,.,.' "'. ....... ".-.-..'.....,..'..~...,
<br />
<br />.,.,,~',.,..,.....=-............ '.-...----".. ...." ...,.....,.-......-... ,. .,...,..,.,....-....
<br />
<br />Permil.I,lll. ,'c; (I'
<br />I late Penllillecru ---~.--~Z'ldi;;/:::
<br />
<br />Builder "'Janle/Owner Narne _(~-" __I ~(C._ Lb !!l '/)\_ ___ Control if.
<br />II
<br />COltllly Palcell'Jo, ,;,' /) ), I ' rrJ" .. ,), :~'cu~ __L .~ll ~)ub[)lv:
<br />
<br />Addttt8S!locRtlon-' ~:) -- 1_> :~-l _ (:;""_)1. I ,i-
<br />
<br />Classlflcatlon/ Iype of Use
<br />
<br />TRANSP(m rATION IMPACT FEE
<br />
<br />I~are:
<br />
<br />Sq Ft UIIII:
<br />
<br />EXeltlpt [_ ] Yes I ~J No
<br />
<br />Ilow L)etennlned
<br />
<br />II npac! Fee Alllcllltlt $ I -; ~'<3"
<br />--- ,-- -- r--;-- -- ----
<br />
<br />IUlle No.
<br />
<br />TAl:
<br />
<br />srTn6()riMPA(~TFEE-''''-''~'''''--'''''"- .
<br />
<br />m" "-"" -, .."~.." ,.,..,." ",..-" "._~, .",.",..,_,~ .""""'....a "., .~,.
<br />
<br />Accuunt
<br />
<br />(O!jO)
<br />( 0 fii)
<br />(()fin)
<br />. (I2.J)
<br />! ~Yes
<br />
<br />',,.....,,....',.. ."".~, ,., ~:",... '''''.,...,....~.,.' .~, "-~....
<br />
<br />Exempt
<br />
<br />lllnqle..Farnily l.Jet8clJed House
<br />Mohile HOll1e
<br />()tIler F<esl! lential
<br />Collection Fee
<br />I.--J ,,10 Ilow Deten nlned
<br />
<br />AtllOUlI1
<br />
<br />$
<br />
<br />-'-"'-'-_"'__'U' _ .____..
<br />
<br />. J') Ah'i<fr,Wi f'i' f~ F:iffiE Afl() t.fFE fro<' .., -.. -"..~".. '-" ._c..._. . -"~""'" .------."- --" --__ ~ __._.,..."._
<br />Lalld AceIJI till Land Credit Land Total
<br />
<br />- -". .--- ,- --- ...----- --- - - ~. --....
<br />
<br />.. ~. ~..-~.".,..''''<..._-,.."..............~....- ......'.... -. p" ".--....."'.........
<br />
<br />nor:I!~alil)1l ACCUllIlt
<br />
<br />HeCleatinll C;FfH.iil
<br />
<br />HecleatiollTotal
<br />
<br />ZOlle
<br />
<br />n.>TAI. I\MC)UNT
<br />
<br />(I'
<br />d
<br />-_. .,--- -,,-- ...- - ----._~-_.__..
<br />
<br />Exelllpt / I I Yes [] 1'10
<br />
<br />llow Uetermined
<br />
<br />...' , f-f:~;, ",..." ...''"..........' '_' ......_ ..;..- ."'.....".,
<br />LlBnARY FFE
<br />I.alld AI;COI II II
<br />
<br />-. "-.----'-"--'" - ,-_. .-. ...--., -..-.-. ..-.------.--.. '-'-... -.----.-.--. "--'-
<br />
<br />.,ft..' ',.,-..~ ~. U' ".~.' "."....,.~,-_..._,.".~..., ",.,'"...,.~~".."_.,._ _ . _._,..''''...,......_.,., '-:u... ,,.,,-'c.......,,.,, .....-"-....---._..u""......, .."'.~~.,_~. .,.,__.,_~"".......,....".."...__....."......".......___.~..,,"'-....
<br />
<br />Lalld Credit
<br />
<br />.-'--"..:.------....-,..---...--..-.. ."
<br />
<br />Lalld TntHI
<br />
<br />Foeilily J\CCOltlll
<br />
<br />'-. ..- ~-"'--" ----. ..~--._._-. -..~-....
<br />
<br />""----...-._...~-. --
<br />
<br />I::adlity C:n'ldll.
<br />
<br />Facility Total
<br />
<br />EX8111prJ I Yes '-_I I'Jo
<br />
<br />Ilow Uelellllllled
<br />
<br />Total AlllOllllt
<br />
<br />_....-.~x:;::.. ..... '''~'''''''''''_''''" "....""........".",.,
<br />RESOURCE FEE
<br />lUIN AMUUHT
<br />
<br />, ",' ,..- - ... ~~,,,.~ r_..
<br />
<br />"""".r '-..,.,.....,..""--" ..,....,.Il..".""-..... ~~'.., ...-.... "" ..-.,..,.~,.".~,.....-,,.......,,,,,,,,,, ..'.. e.'," '_"-.~"', n... .......-.w_.... ..~,.. ""-''''''_'''''''_n. ...'.~~'L'-......-n........."J,.....~~,.___,~.......".,_....... ".-~,..._,.w.
<br />ERU
<br />
<br />. ...,........,~.. '..''''.........,'' ....,.-.,-
<br />
<br />PIFJIH_"lled HV
<br />
<br />. CI18cked By
<br />
<br />NO Cl:HTIFICATF. ()F OCCUI'ANCY WILL Bf~ ISSUED on. FINAL INSPECTION
<br />PEHF()RIVlf:U UNTil. 'f HE TOTAL AMOUNTS LISTED HAve
<br />BEEN PAil) AND
<br />HeCr.IP'n~n FOR BY ^ GENlRAL PERMITTING OI~FIGE OF PASCO COUNTY
<br />
<br />N:kn()wl(~duelnp.nt hp,low does Illlt hnply 8cneptanc8 of C0I1Cllll8nc8, bill simply receipt of A copy of this fOllll, plal;lnq
<br />the hulldill(.l permit owner Iln notice of tills assessment and the condit/OilS of paY1I1A1l1 for sarne.
<br />
<br />DATE
<br />
<br />~-.._---- - -----. ....-. ___... '._h___ _
<br />
<br />I ~ECEI\lEr) BY
<br />
<br />HECE/f'r I.l( ,_
<br />
<br />(IAll:
<br />
<br />DY
<br />
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