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= RASCO COUNTY, FLORIDA <br /> � Permlt No, �y � 7 0 <br /> Date Permitted <br /> Builder Name/Owner Name i���'1�C-�- !'�i'✓�� �' Control # <br /> CountyParcelNo.03-�-�/-U23G—��%K��U9(d SubDiv: i�� T���� <br /> Address/Location (o Z�(o f cYu.V�-��1 ��'`Q �� �� � R � <br /> ClassificatlonlType of Usg �DuJ� ���Q- ►''�5�'�+`W <br /> TRANSPORTATION IMPAGT FEE � Rate: Sq Ft Unit; 3� <br /> Exempt [] Yes � No How Determined <br /> Impact Fee Amount $� c�-�O . Zone No. TAZ: <br /> SCHOOL IMPACT FEE � <br /> Account (056) Single-Family Detached House Amount $ j �� 5� •� 0 <br /> (057) Mobile Home <br /> (058) Other Residential <br /> 123) Collectlo� Fee <br /> Exempt a Yes [] No How petermined <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Rec�eation Credit Recreation Total <br /> Zone TOTAL AMOUNT $ '] (�iR, 5(� <br /> Exempt � Yes � No How Determined <br /> LIBRARY F�E <br /> �.and Account Land Credit Land Total <br /> Facility Account Facfljty Credit Facllify Total <br /> Exempt � Yes [] No How Determined Total Amount �_ <br /> RESOURCE FEE ERU � <br /> TOTALAMOUNT <br /> Prepared By -� Checked By <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE <br /> RECEIPTED FOR BY A CENTRAL PERMITI' N(3 O�FICE OF PASCO COUN'1�f <br /> Acknowledgement betow does nol Imply acceptance of concunenpe, but slmplyi recelpt of a copy of lhis form, placing <br /> the bullding permtt awner on notice of thls assessment and the condltlons af paymenl for same. <br /> pATE R�CEIVER BY <br /> RECEIRT NO. �_ pqTE BY <br />