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. ,' <br /> :� � � ; � SCO CCIUNTY, �LORIDA <br /> : <br /> P� . <br /> : � � Permit No. � � <br /> Date Permitte�3n — I / <br /> _---, <br /> p,,� �� Control # � <br /> Builder NamelOwner Name � Y r 1 ��Y , Q <br /> Coun ty Pa r c e l N o. 3' 2� ' 2� d��� � f <br /> �-( j 0 Su b D i v: c a- � G"�� f'"�� �' <br /> AddresslLocation ����` �`� � � <br /> Classification/Type ot Usg (°Si ����� V� r `� <br /> TRANSPORTATION IMPACT FEE - Rate: Sq Ft Unit; �� 1 � <br /> Exempt ❑ Yes ❑ No How Determined <br /> � Impact Fee Amount $, �p Zone No. T'�� <br /> SCHOOL 1MPACT FEE �1� <br /> Account (056) Single-Family Detached House Amount $ �� 5 7��.- <br /> (057) Mobfle Home <br /> (058} Other Rasidential <br /> 123) Collection Fee <br /> Exempt �] Yes [� No How Determined <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Rec�eation Credit Recreation Total <br /> Zane TOTAL AMOUNT $� Cn �,,,. S� <br /> Exempt ❑ Yes ❑ No How Determined <br /> � <br /> LIBRARY F�E <br /> �.and Account �and Credit Land Total <br /> Facility Account Faciljty Credit Facility Tota) <br /> Exempt [� Yes ❑ No How Determined Total Amount � <br /> RESOURCE FEE ERU � <br /> TOTAL AMCIUNT � �" , �J � <br /> Prepared By � Checked Ry <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL (NSPECTIQN <br /> PERFORMED UNTIL THE TOTAL AMOUNTS LI5TED HAVE <br /> BEEN PAID AND <br /> REC�IPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY <br /> Acknowledgement below does not Imply acceptance of concurrenoe, but simply recelpt of a copy of thi5 form, plaGing <br /> the building permit owner on notice of this assessment and th� conditlons af paXment for same. <br /> DATE R�CEIVER BY <br /> RECEIPT NO. DATE BY <br />