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PASCO COUNTY, FLORIDA Permit No., o3><?J9 Date Permitted Builder Name/Owner Name DAu\D ~~tJY\ Control # County Parcel No. SubDiv: Address/Location ~43~ V,cJu...its \'\1\\ \ \ .-Ave 2-h:J\ <\ s3)L{j ClassificationfType of Use Single Family Residence TRANSPORTATION IMPACT FEE Rate: Sq Ft Unit: Exempt DYes D No How Determined Impact Fee Amount Zone No. TAl: SCHOOL IMPACT FEE Account (056) Single-Family Detached House (057) Mobile Home (058) Other Residential .J:123) Collection Fee Exempt U Yes D No How Determined Amount $ PARKS AND RECREATION FEE Land Account Land Credit Land Total Recreation Account Recreation Credit Recreation Total Zone TOTAL AMOUNT Exempt DYes D No LIBRARY FEE Land Account 157 How Determined Land Credit Land Total Facility Account 240 Facility Credit Facility Total Exempt DYes D No How Determined Total Amount RESOURCE FEE TOTAL AMOUNT d L (od- ERU IIi- Prepared By Checked By NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE BEEN PAID AND RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY I I I I Acknowledgement below does not imply acceptance of concurrence, but simply receipt of a copy of this form, placing the building permit owner on notice of this assessment and the conditions of payment for same. DATE RECEIVED BY RECEIPT NO. '&4 8/43 DATE ~ /18/6S BY I / Gct~.