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;� � _ �: RASCO COUNTY, FLORIDA <br /> • Permlt No. ( Z / 7 � <br /> Date Permitted <br /> Bullder Name/Owner Name � u-1� Tt��' `' 1� Control # <br /> County Parcel No. 03 "�-� °� ��'��� "� ��-' SubDlv: G 1 a� <br /> Address/Locatfon („ Z� � �i ��T �4���� � � � q 2 " <br /> Classi�cation/Type of Us@ ��'� h �'�`� �'-J� � <br /> TRANSPORTATION IMPAGT FEE � Rate: Sq Ft Unit; �,�_ <br /> Exempt ❑ Yes � No Haw Determined <br /> ' Impact Fee Amount $ 3 � `�go� � Zone No. TAZ: �_ <br /> SCHOOL IMPACT FEE `� <br /> Account (056) Single-Family Detached House Amount $� � 7� 't'� ' <br /> (057) Mobile Home <br /> (058) Other Residential <br /> 123) Collection Fee <br /> Exempt (� Yes [] No How petermined <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreation Total <br /> Zone TOTAL AMOUNT $��Q� � S W <br /> Exempt ❑ Yes � No How Determined <br /> LIBRARY FEE <br /> land Account �and Credit Land Tota) <br /> Facility Account Faciljty Credit Facllify Total <br /> Exempt � Yes � No How Determined Total Amount �i <br /> RESOURCE FEE ERU ` <br /> TOTALAMOUNT <br /> Prepared By Checked By <br /> NO CERTIFICA7E OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEIP7ED FOR 8Y A CENTRAL PERMITTING O�FICE.OF PASCO COUNTY <br /> Acknowledgement below does not Imply acceptence of concurrenpe, hut simply recelpt of a copy of this form, placing <br /> the bullding permit owner on notice of thla assessment and fha condlUons of payment for same. <br /> DATE R�CEIVER BY <br /> RECEIPT NO DATE BY <br />