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, <br /> r� '' ',; <br /> ; ` �: r RA�CO CQUNTY, �'LOI�IDA <br /> � ; .. <br /> Permit No, � ( ���_ <br /> Date Permltted 3 - t <br /> Builder Name/�wner Name � P �'1 n�- ��� ��5� Control #� <br /> Count Parcel No. b 3`� " Z-1- �j Z�p� � ��J..�" C�7�ubDiv: � l�-n '�� <br /> y �Q� � �� � <br /> AddresslLocation � � � ( � `�-►4-r � �y� ' "" �) 3 <br /> �-�,' b��l�a�-�e. <br /> Classification/Type of Us@ �'e �' �e�l �-f'� , <br /> TRANSPORTATION IMPACT FEE � Rate: Sq Ft Unit; � S_ 3.�___..._ <br /> Exempt [] Yes [� No HoW Determined <br /> ' Impact Fee Amount $ 3 TC�C� , Zone No T�� <br /> SCHOOL IMPACT FEE �( <br /> Account (056) Single-Famlly Detached House Amount $,_ �� 5 �' 't'� " <br /> (057) Moblle Home <br /> (058) Other Residential <br /> 123) Collection Fee <br /> Exernpt � Yes ❑ No How petermined _ <br /> PARKS AND RECR�ATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreatfon Credit Recreation Total <br /> Zone TOTAL AMOUNT $ � �2 q -5� <br /> Exempt [] Yes � No How Determined <br /> LIBRARY F�E <br /> Land Account Land Credit Land Total. <br /> Facility Account Facll�ty Credlt Facllify Total <br /> Exempt [] Yes ❑ No How Determ(ned � Total Amount - <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT ' <br /> Prepared By ' Checked �y <br /> NO CERTIFICA7E OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTIQN <br /> PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A C�NTRAL PERMiTTING ��FIGE OF PASCO COUNTY <br /> Acknowledgement below doea not Imply acceptance of concurrenpe, but simply recelpt of a copy of this form, plaoing <br /> the building permit awner on notice of thls asssssment and th� condltions pf payment for same. <br /> QATE R�CEIVEI] BY <br /> RECEIRT NO. DATE BY <br />