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_� � � �: RASCO COUNTY, FLORIDA <br /> Permit No. � 2 z0 O <br /> Date Permitted <br /> Builder Name/Owner Name �,, ���Ctr �eS Control #' <br /> County Parcel No. �j3- �� 2-I -�.SZ� — d���- � 3�� SubDiv: � ,� ��d � <br /> Address/Location �(n � � �'�t �r � ��Z <br /> Classification/Type of Use ��1 � 1� �l)U3Y1 �'lL� ����T�O�' <br /> 7RANSPORTATION (MPAGT FEE . Rate: Sq Ft Unit; � 3 <br /> Exempt � Yes [� No How Determined <br /> ' Impact Fee Amount $ 34 �� • Zone No. TAZ: <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $ �.�7 S 7' �- d <br /> (057) Mobile Home , <br /> (058) Other Residential <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 /> Zone TOTAL AMOUNT $� fe� < 5,�, <br /> Exempt � Yes � No How Determined <br /> LIBRARY F�E <br /> Land Account Land Credit Land Total <br /> Facility Account Facility Credit Fac(lify Total <br /> Exempt � Yas � No How Determined Total Amount `� <br /> RESOURCE FEE ERU � <br /> TOTALAMOUNT � <br /> Prepared ey Checked Sy <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTIL THE TOTAL AMUUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMI7TING OFFICE.OF PASCO COUNTY <br /> Acknowledgement below does not Imply acceptance of concurrenpe, but slmply recelpt of a copy of this form, placing <br /> lhe bullding permlt owner on notice of thls assessment and fhe condlUons of payment for same. <br /> DATE R�CEIVER BY <br /> RECEIPT NO DATE BY <br />