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;� �: Pi4SCU COUNTY, FLORIDA <br /> Permit No. � LZ� �O _ <br /> Date Permitted 8 - / lv - 1 / <br /> euilder Name/Owner Name � p y� n ar �eS 1�G Control # <br /> County Parcel No. (�3-Z(� ZI - U�3p- Q(�OC�C�- ��� SubDiv: �� anr�I lGc,c)rl�MYye� � <br /> Address/Location 3'� b � �7 ��'+4 <<• n �d � �G�� / � � � <br /> Classification/Type of Use ��n hbti-Y,� <br /> TRANSPORTATION IMPACT FEE , Rate: Sq Ft Unit: Z <br /> Exempt �] Yes [� No How Determined <br /> Impact Fee Amount $�� g G Zone No. TAZ: <br /> SCHOOL iMPACT FEE � I) <br /> Account (056) Single-Family Detached House Amount $ ��� 7��1 <br /> (057) Mobile Home <br /> (058) Other Residential <br /> 123) Collection Fee <br /> Exempt Yes [� No How petermined <br /> PARKS AND RECR�ATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Rec�eation Credit Recreatlon Total <br /> Zone TOTAL AMOUNT $ f 7 (o� � S� <br /> Exempt � Yes � No How Determined <br /> LIBRARY F�E <br /> Land Account Land Credit Land Total <br /> Facility Account Facflity Credit Facflity To1al <br /> Exempt � Yes � No How Determined Total Amount <br /> RESOURCEFEE ERU � <br /> TOTAL AMOUNT • <br /> Prepared By '� � � Checked Sy <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE <br /> RECEIPTED FOR BY q CENTRAL RM ITI' NG OFFICE OF PASCO COUNTY <br /> Acknowledgement below does not Imply acceptance of concurrenoe, but slmply recelpt of a copy of this form, placing <br /> lhe building permit owner on notice of this assessment and tha condidons pf paymenl for same. <br /> QATE R�CEIVER BY <br /> RECEIPT NO �_ pATE BY <br />