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. J <br /> ,,f <br /> ;� � ; p��CQ CQUNTY, FLOt�IDA <br /> � ; ,. <br /> � <br /> � r ' Permit No, ( � <br /> Date Parmi�ted -�vo -L ( <br /> Builder Name/Owner Name ���-r `�-�t�`e-S � L Control #' <br /> � 1�Q,� � �A � <br /> County Parcel No. () 3- Z(o - Z j- d 2-O�C� � �0 �� �)3�bDiv: �� 1�� <br /> AddresslLoca n'� j�� } yv`�j�e,r ��✓1��1 �� <br /> Classificatlon/Type of Us� �C' S�� ���� v � L(a <br /> TRANSPORTATION IMPACT FEE , Rate: Sq Ft Unit; I y 4O <br /> Exempt [] Yes ❑ No HoW Determinsd <br /> � Impact Fee Amount $�`f �� Zone No. T�� <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $ � 7� � <br /> (057) Moblle Home <br /> (058) Other Residentfal <br /> 123) Collection Fee <br /> Exempt [� Yes [] No How Determfned <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credlt Land Total <br /> Recreation Account Recreation Credit Recreation Total <br /> Zone TOTAL AMOUNT $� 6 q•�J �_ <br /> Exempt [] Yes [� No How Determined <br /> LIBRARY F�E <br /> �and Account Land Credit Land Total <br /> Facility Account Facility Credit Facility Total <br /> Exempt � Yes ❑ No How Determined • Total Amount �_ <br /> RESOURCEFEE ERU <br /> TOTAL AMC�UNT � �� , �� � <br /> Prepared By � Checked Sy <br /> NO CERTIFICA7E OF OCCUPANCY WILL BE ISSUED OR FINAL (NSPECTIQN <br /> PERFORMED UNTIL 7HE 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 concurrenoe, but slmply recelpt of a copjr of thls form, placing <br /> the bullding permit owner on notice of thls assessment and th� condltions af payment for same, <br /> DATE R�CEIVED BY <br /> RECEIPT NO. DATE BY <br />