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;� � `: RASCO COUNTY, FLORIDA <br /> Permit No. ���_ <br /> Date Permitted <br /> Builder Name/Owner Name ��►'1(1C�� �S Control # <br /> county Parcel No. (�3 2 6- �1- b�� ��� "'"1`�SubDlv: i�1 � <br /> Address/Location (e �`� � n'�-� "'" `� � �� � � <br /> Classificalion/Type of Usg — rf�cx�,,� �, lC��l(1 YIGI'�2 <br /> TRANSPORTATION IMPAGT FEE � Rate: Sq Ft Unit; ��Q � <br /> Exempt [] Yes ❑ No HoW Determined <br /> Impact Fee Amount $�T� Zone No. T�� <br /> SCHOOL IMPACT FEE J I <br /> Account (056) Single-Family Detached House Amount � ����• `�l) <br /> (057) Mohile Home <br /> (058) Other Residential <br /> 123) collection Fee <br /> Exempt [� Yes [] No How Determined <br /> PARKS AND RECR�ATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Rec�eation Credit Recreation Total <br /> Zone � TOTAL AMOUNT $ �LQ q ' �.p <br /> Exempt �] Yes � No How Determined <br /> LIBRARY FEE <br /> �.and Account Land Credit Land Total <br /> Facility Account Faciljry Credlt Facllify Total <br /> Exempt � Yes ❑ No How Determined Total Amount � _ <br /> RESOURCE FEE ERU <br /> TOTALAMOUNT � <br /> Prepared By ' Checked �y <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 BY A CENTRAL PERMITTINl3 O�FICE OF PASCO COUNTY <br /> Acknowledgement below doea not imply acceptance of concurrence, but slmply recelpt of a copy of this form, placing <br /> the building permlt owne� on nolice of this assessment and tha condllbns af paymenl for same. <br /> pATE R�CEIVEQ BY <br /> RECEIRT NO. DATE gY <br />