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,�� <br /> , 1 4 • ,1 � <br /> ,� � .. ; �A�CO COUNTY, FLDI�IDA <br /> � <br /> .. Permit No, �� <br /> Date Permitted 3 ° � � - � � <br /> C� Control # � <br /> Builder Name/�wner Name �� ^, <br /> County Parcel No, ��" - Z � - <br /> 30 - OC��� �7 SubDiv: �-� ��1 �� <br /> AddressJLocation � � ��' <br /> i�o( � 7£'� � <br /> Classificatlon/Type of Us@ e F���� T�� V l �� S <br /> TRANSPORTATION (MPACT FEE � Rate: <br /> sq �t unit; 3 <br /> Exempt ❑ Yes ❑ No How Determined <br /> ' Impact Fee Amount ,$ �J't V O• Zone No. T�� <br /> SCHOOL 1MPACT FEE , <br /> Account (056) Single-Family Detached House Amount $ �� 5� ` U <br /> (057) Moblle Home <br /> (058) Other Residentiai <br /> 123) Collection Fee <br /> Exempt [� Yes ❑ No How Qetermined <br /> PARKS AND RECR�ATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account � Recreation Credit Recreation Totat <br /> Zone TOTAL AMOUNT $ � � � �� s � <br /> Exempt ❑ Yes [� No How Determined <br /> LIBRARY FEE � <br /> l.and Account Land Credit Land Total <br /> Facility Account Faciljty Credit Facllity Total <br /> Exempt � Yes ❑ No How Determined Total Amount �-�c�" <br /> RESOURCEFEE � ERU <br /> TOTAL AMCIUNT � <br /> Prepared By Checked Sy , <br /> NO CERTIFICATE OF OCCUPANCY WII.L BE ISSUED OR FINAL INSPECTIQN <br /> PERFORMED UNTtL THE TOTAL AMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> REC�IPTED FOR BY A CENTRAL PERMITTIN(3 OFFICE OF PA3C0 COUNTy <br /> Acknowledgeme�t below does not Imply acceptance of concurrenoe, but slmply recelpt of a copy of thl$ form, placing <br /> the bullding permlt owner on noilce of thls assessment and th� conditlons af paXment for same. <br /> RATE R�CEIVEQ BY <br /> RECEIPT NO. DATE BY <br />