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<br /> <br />PASCO COUNTY, FLORIDA <br /> <br />Builder Name/Owner Name <br /> <br />c~ <br /> <br />f4-R(w~j <br /> <br />County Pa~cel No. <br /> <br />SubDiv: <br /> <br />ClassificationfType of Us~ <br /> <br />'67 Lf':2.<..( C./{( I\\J--t! , <br />~,,~ ~E' ~ <br /> <br />Address/Location <br /> <br />TRANSPORTATION IMPACT FEE, Rate: <br />Exempt 0 Yes ~o How Determined <br /> <br />Sq Ft Unit: <br /> <br />Impact Fee Amount $ I S~ <t <br /> <br />Zone No. <br /> <br />TAl: <br /> <br />SCHOOL IMPACT FEE <br />Account (056) Single-Family Detached House <br />(057) Mobile Home <br />(058) Other Residential <br />j) 2)} Collection Fee <br />Exempt Lf'Y'es 0 No How Determined <br /> <br />Amount $ <br /> <br /> <br />PARKS AND RECREATION FEE <br />Land Account Land Credit <br /> <br />Land Total <br /> <br />Recreation Account Rer:r~atief\ ClOOn Recreation Total <br />Zone _____________, ' TOTAL AMOUNT $ <br />~ DYes 0 No How Determined <br /> <br />LIBRARY FEE <br />Land Account <br /> <br />Land Credit <br /> <br /> <br />Facility Account <br /> <br /> <br />Facility Total <br /> <br /> <br />ONo <br /> <br />How Determined <br /> <br />Total Amount <br /> <br />RESOURCE FEE <br />TOTAL AMOUNT <br /> <br />\~ , l Q?5' <br /> <br />ERU <br /> <br />Prepared By <br /> <br />Checked By <br /> <br />NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION <br />PERFORMED UNTIL THE TOTAL AMOl)NTS LISTED HAVE <br />BEEN PAID AND <br />RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY <br /> <br />Acknowledgement below does not Imply acceptance of concurrence, but simply receipt of a copy of this form, placing <br />the bUilding permit owner on notice of this assessment and thEl conditions of payment for same. <br /> <br />DATE RECEIVED BY <br />RECEIPT NO. \. ~(~"- \0 DATE \:1:1-1 ~O\-LBY "\:), \;." \ "(,,'f'J'-- <br /> <br />: \ <br />