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?� ;: RA�CO COUIVTY, FLORIDA <br /> Permit No, � � I <br /> Date Permitted �,_30 - 11 <br /> Builder Name/Owner Name ��E n r1 e� r 't�'�'� S� CoNrol # <br /> CountyParcelNo. b3'Z6-Z� '"OZ�^(��?��a?� dSubDiv: Ckrl � <br /> Address/Location .� � � � J 1'� � U.�_ � �`^ R � � � t° <br /> Classification/Type of Us@ �� �Si U�.n'tt W' t�� r l� - <br /> TRANSPORTATION IMPACT FEE � Rate: Sq Ft Unit: J� 3) <br /> Exempt � Yes [] No Haw Determined <br /> Impact Fee Amount $ 3'� �O � Zone No. TAZ: <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $ ���� �� <br /> (057) Moblle Home <br /> (058) other Residentfal <br /> 123) Collectio� Fee <br /> Exempt Yes [] No How petermined <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Rec�eation Credit Recreation Total <br /> Zone TOTAL AMOUNT $ �] � � �S� <br /> Exempt [] Yes � No How Determined <br /> LIBRARY FEE <br /> �and Account Land Credit Land Total <br /> Faciiity Account Faciljty Credit Facflity Total <br /> Exempt � Yes � No How Determined Total Amount �_ <br /> RESOURCEFEE ERU <br /> TO7ALAMOUNT • <br /> Prepared By � Checked sy <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTIpN <br /> PERFORMED UNTIL 7HE TOTAL AMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMITI'IN(3 O�FICE OF PASCO COUNTY <br /> Acknowledgement below doea not Imply acceptance of concurrenoe, 6ut slmply recelpt ot a copy of thls form, placing <br /> the building permit owner on notice of thls assessment and th� condiqons of payment for same. <br /> DATE R�CEIVER BY <br /> RECEIPT NO. DATE BY <br />