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;� ' : PASCO COUNTY, FLORIDA <br /> • Permlt No. Z Z U <br /> Date Parmitted - / � <br /> Builder Name/Owner Name Q Y1 f1 Cc r S��ontrol # <br /> --• .--, C.�'� <br /> County Parcel No. ��- 2Ip - Zj'�2�0" ����' ��`SubDiv: 1� ( �w� °� <br /> Address/Location �� �P 1 3 1'�'►ri" H �Un t� � � � � � <br /> ClassificationlType of Usg I ��J�l � �� <br /> TRANSPORTATION IMPACT FEE Rate: Sq Ft Unit; � 3 <br /> Exempt [] Yes [] No Haw Determined <br /> ' Impact Fee Amount $ 3�� Zone No. T�� �- <br /> SCHOOL IMPACT FEE (, <br /> Account (056) Single-Family Detached House Amount $ �� S' '`�" � <br /> (057) Mobile Home <br /> (058) Other Residential <br /> 123) Collaction Fee <br /> Exempt [� Yes � No How peterm(ned <br /> PARKS AND RECR�A'TION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credit Recreatlon Total <br /> Zone TOTAL AMOUNT $ � �p �• ��, <br /> Exempt � Yes � No How Determined <br /> LIBRARY F�E <br /> Land Account �and Credit Land Total <br /> Facility Account Faciljty Credlt Facility Total <br /> Exempt � Yes ❑ No How Determined Total Amount � <br /> RESOURCE FEE ERU � <br /> TOTALAMOUNT � <br /> Prepared By Checked 8y <br /> NO CERTIFICATE OF OCCUPANCY WILL 8E ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMITTING O�FICE OF PASCO COUNTY <br /> Acknowledgement below doea not Imply acceptance of concurrenae, but slmply recelpt of a copy of this form, placing <br /> the bullding permit owner on nollce of ihls assessment and th� condfUons pf payment for same. <br /> QATE R�CEIVED BY <br /> RECEIPT NO DATE BY <br />