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� <br /> 1 <br /> ` ''� LORIDA <br /> �� `r RA�CO C4UNTY� � , . <br /> , . <br /> , ,� <br /> Permit No, ��� 2 _'" — <br /> ermf ted l 3– �o_ <br /> �at� r t <br /> �� n � ��S �c Control # � <br /> Builder Name/Owner Name n r � <br /> b 3,,.. Z( _2 �– Q2� -- �����SubDiv; i `f <br /> County Parcei No. n g � 2 <br /> � � �9-_��l_ KG� � K�� <br /> AddresslLocation ��� � 2 ) <br /> Classification/Type of Us� 1�..����'e-�� � ���h�7Y�'�- <br /> TRANSPORTATION IMPACT FEE � Rate: <br /> sq Ft unit; 1 3�1 1 <br /> Exempt ❑ Yes ❑ Na How Determined <br /> � Impact Fee Amount $ <br /> 3 �} � , zone No. T�� <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount � �� S�� �- <br /> (057) Moblle Home <br /> (058) Other Residential <br /> 123) CollectioCl Fee <br /> Exempt � Yes ❑ No How [?etermined <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> F�ecreation Account Rec�eation Credit Recreatlon Total <br /> Zone TOTAL AMOUNT $ r I �� � �� <br /> Exampt [� Yes [� NQ How Determined <br /> LIBRARY F�E � <br /> �.and Account Land Credit r Land Total <br /> Facility Account Facility Credit Faciilty Total , <br /> Exempt ❑ Yes ❑ No How Determined � Total Amount _�! <br /> �RESOURCE F�E ^ ERU ,�, <br /> TOTAL AMOUNT <br /> Prepared By � Checked Ry <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTIpN <br /> PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEiPTED FOR BY A C�NTRAL PERMITTING 4FFICE OF PA3C0 COUNTY <br /> Acknowledgement below does not Imply acceptance of concurrenoe, but simpiy recelpt of a copy of thfs form, plaoing <br /> the building permit owner on notice of thls assessmenl and tha conditions af pa�rment for same, <br /> DATE � RECEIVELI BY <br /> RECEIPT NO. DATE BY <br />