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= PA�CO COUNTY, FLOC�IDA <br /> Permit No. � � �'� � <br /> Date Permitted <br /> � �e S Control # <br /> Builder Name/Owner Name P��a �" <br /> County Parcel Na p3� �-E' OZSa�-�� <br /> c��a- ( 3fa SubDiv: �t �� ��"�� <br /> Address/Location .3 � � � �° c a �� � l3 <br /> Classification/Type of Use r��°� �� �� h �� � ��\� <br /> TRANSPORTATION IMPACT FEE � Rate: Sq Ft Unit; <br /> Exempt [] Yes [� No HoW De.termined <br /> Impact Fee Amount � 34 g� � Zon.e No. T�� .-- <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $ �� S 7� �-� <br /> (057) Moblle Home <br /> (058) Other Residentlal <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 Recreation Credit Recreation Total <br /> Zone TOTAL AMOUNT $ � � �1 ' s� <br /> Exempt ❑ Yes � No How Determined <br /> LIBRARY F�E <br /> Land Account Land Credit Land Total <br /> Facility Account Facll�ty Credit Facllity Total <br /> Exempt � Yes ❑ No How Determined Total Amount � <br /> RESOURCE FEE ERU � <br /> TOTALAMOUNT � <br /> Prepared ey � • � vU�� Checked �y <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTIL THE TOTAL AMUUNTS LISTED HAVE <br /> BEEN PAID AND <br /> REC�IPTED FOR BY A CENTRAL PERMITTING O�FICE OF PASCO COUNTY <br /> Acknowledgement below does not Imply acceplance of concurrenpe, 6ut simply recelpt of a copy of this form, placing <br /> the building permlt owne� on notice of this assessment and tha condltlons af payment for same. <br /> DATE R�C�IVEQ BY <br /> RECEIPT NO. DATE BY <br />