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. ,. <br /> ',, <br /> ? � 5 �i �A�CO C4UNTY, �LOf�IDA � <br /> � Permit No, �/ �� d � <br /> Date Permitted - 3 � r f <br /> Builder Name/Owner Name ���'la-r �� �� Control # ' <br /> County Parcel No. C9 � � �� l Zl � �2 30 ~ ��� " b �v SubDiv. � ������ �� � `� <br /> Address/Location ��� � 7 �-F' Y� 1 n � �a � O <br /> Classification/Type of Us� ��� �����' ��n h��`� <br /> TRANSPORTATION IMPACT FEE , Rate: Sq Ft Unit; I�7 � <br /> Exempt ❑ Yes [] No How Determined <br /> � Impact Fee Amount $ 3 T g� � Zone No. TAZ: <br /> SCHODL IMPACT FEE ' <br /> Account (056) Singie-Family Detached House Amount $ ��!� �7 4 <br /> (057) Moblle Home <br /> (058) Other Residentiai <br /> 123) Collection Fee <br /> Exempt �] Yes � No How Qetermined <br /> PARKS AND RECREATION FEE " <br /> Land Account Land Credit Land Total <br /> Recreation Account Rec�eation Credit Recreation Total <br /> Zone TOTAL AMOUNT $ � �q • S (� <br /> Exempt [] Yes [� No How Determined <br /> LIBRARY FEE <br /> l.and Account L.and Credit Land Total <br /> Facility Account Facility Credit Facllity Total <br /> Exempt � Yes [] No How Determined � Total Amount �.�__ <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT � <br /> Prepared By � Checked Sy <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTIpN <br /> PERFORMED UNTIL 7HE TOT'AL AMOUNTS LISTED HAVE <br /> BE�N PAID AND <br /> REC�IPTED FOR 8Y A CEhiTRAL PcRMiT'TING OFFICE OF PA8C(� CQUN'i�( <br /> Acknowledgement below does not Imply acceptance of concurrenGe, but simply recelpt of a copy of thl� form, placing <br /> the bullding permit owne� o� notice of this assessment and th� conditions pf payment for same. <br /> RATE � R�CEIVELI BY <br /> RECEIPT NO. DATE BY <br /> "�`.,,.� . <br />