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'; <br /> ;�� � � . ; P,ASCO COUNTY, �L.OF��DA <br /> ; <br /> . Permit No. � � � <br /> pate Permitted 3___=.,�__�_ -� � � <br /> 'ider Name/�wner Name �.P� � r L'�"' `e S�cControl #' <br /> eui �ar� hl��a � <br /> County Parcel No, (3..3 ~Z �' Z��' b2 � " ��� �1 ��SubDiv. � � <br /> `— ' � � �n � ( 33� <br /> �� 1��� ( � � �e� <br /> Address/Locat on <br /> '�� �-�� I�1( �� � <br /> ClassificationlType of Us� � <br /> TRANSPORTATION IMPACT FEE � Rate: Sq Ft Unit; S I <br /> Exempt [] Yes ❑ No How Determined <br /> ' Impact Fee Amount $ 3��- zone No. T� <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $�, ^ 7 � 7� � <br /> (057) Mobile Home <br /> (058) Other Residentfal <br /> 123) Collection Fee <br /> Exempt [] Yes ❑ No How Determ(ned <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recl•eation Credit Recreatlon Total <br /> Zone TOTAL AMOUNT $ �q . 5 � <br /> Exempt ❑ Yes ❑ No How Determined <br /> LIBRARY FEE <br /> Land Account Land Credit Land Total <br /> Facility Account Facility Credit Facility Total <br /> Exempt [] Yes [� No How Determined Total Amount � <br /> RESOURCE FEE � * n�, ERU <br /> TOTAL AMOUNT C�� <br /> Prepared By � Checked Sy <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTIUN <br /> PERFORMED UNTIL THE T�TAL AMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A rENTRAL P�RMITTING OFFICE OF PASCO COUNTY <br /> Acknowledgement below does not imply acceptance of concurrence, but simply recelpt of a copy of this form, placing <br /> the bullding permit owne� on notice of ihis assessment and tha conditions of payment for same. <br /> DATE R�CEIVEQ BY <br /> REGEIPT NO. DATE BY <br />