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_� RA�CO COUNTY, FLORIDA <br /> Permit No. l! � � <br /> Date Permitted �3 -3 � - /1 <br /> Builder Name/Owner Name ���►' �'�-� a�C- Control # <br /> County Parcel No. (��J Z-Z l- 30 - 007�a'�7 SubDiv: � l�Gt �� <br /> Address/Location 7 Q ��� �� � 7 � <br /> Classification/Type of Us� ��5���-nr� � ��%'� <br /> TRANSPORTATION IMPACT FEE � Raie: Sq Ft Unit; •. 5 3 1 <br /> Exempt [] Yes ❑ No HaW Determined <br /> Impact Fee Amount $�� � O Zone No. T�� <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $^(���" 4 U <br /> (057) Mobfle Home <br /> (058) Other Residentlal <br /> 123) Collection Fee <br /> Exempt [� Yes [] No How Aetermined <br /> PARKS AND RECR�ATION FEE <br /> Land Account Land Credit Land Totai <br /> Recreation Account Rec�eation Credit Recreation Total <br /> Zone TOTAL AMOUNT $ � �P �. J � <br /> Exempt � Yes � Np How Determined <br /> LIBRARY FEE <br /> �and Account Land Credlt Land Total <br /> Facility Account Facillty Credit Facllity Total <br /> Exempt � Yes � No How Determfned Total Amount �—� <br /> RESOURCE FEE ERU � ' <br /> TO7ALAMOUNT � <br /> Prepared By / , Checked �y <br /> � <br /> NO CERTIFICA7E OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY <br /> Acknowledgement below does not Imply acceptance of concurrenpa, but slmply recelPt of a copy of this form, placing <br /> the building permit owner o� notice of thls assessment and th� condiUons pf paymenl for same. <br /> DATE R�CEIVEp BY <br /> RECEIPT NO DATE BY <br />