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;� �: PA�CD CQUNTY, FLORIDA <br /> Permit No. Z-� <br /> Date Parmikted 1 <br /> Builder Name/Owner Name � � �+ �►i�-,-� �vles �ontrol # <br /> Counly Parcel No. �3 •�-�P -�- d 23 D --�'� �OSubDiv: L e�CLrt i�r��� <br /> Address/Location � � �p � � N�►-�' �4 � �l fl K � � �` �o � <br /> Classification/Type of Use � (S�� ��lM � <br /> TRANSPORTATION IMPACT FEE � Rate: Sq Ft Unit; I <br /> Exempt � Yes � No Haw Determfned <br /> Impact Fee Amount $�`C g0 Zone No. TAZ: � <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $ �� J��7� � � <br /> (057) Mobile 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 Recreation Credit Recreation Total <br /> Zone TOTAL AMOUNT $ � �j �' � S� <br /> Exempt � Yes � No How Determined <br /> LIBRARY FEE <br /> Land Account l.and Credit Land Tota) <br /> Facility Account Faciljty Credit Facility Total <br /> Exempt � Yes ❑ No How Determined Total Amount G--�-�_ <br /> RESOURCEFEE ERU - <br /> TOTALAMOUNT � <br /> Prepared By Checked By <br /> r <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTIL THE TOTAL qMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMITTIN(3 OFFICE OF PASCO COUNTY <br /> Acknowledgement below does not Imply acceptence of concurrence, but simply recelpt of a copy of this form, placing <br /> ihe bullding permit owner on notice of ihis assessmenl and th9 conditlons pf paymenl for seme. <br /> pATE R�CEIVEI] BY <br /> RECEIPT NO. �_ DATE BY <br />