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_� �: PASC� CDUNTY, �LORIDA <br /> • • Permit No. � Z <br /> Date Permitted - -� <br /> euilder Namel�Jwner Name �; R�f�Gc-� �T�� �� Control # <br /> County Pa[cel No. <br /> p3 � Z I-b �3a -� b�0 ' D cgbn SubDiv: ^ �.,- k 1SL� n �d'y+e, s <br /> Address/Location � � � � � � � U n � �� � �� � <br /> Classification/Type of Use �l�\ ��'e- <br /> TRANSPORTATION IMPACT FEE � Rate: Sq Ft Unit; <br /> Exempt � Yes [� No How Determined <br /> ' Impact Fee Amount $ 3� �� Zone No. T�� �- <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $__�._� � <br /> (057) Mobile Home <br /> (058) Other Residantiai <br /> 123) Collsction Fee <br /> Exempt a 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 � TOTAI AMOUNT $ ��9 - S,b <br /> Exempt ❑ Yes � No How Determined <br /> LIBRARY F�E <br /> Land Account �and Credit Land Total <br /> Facility Account Faciljty Credit Facllity Total <br /> Exempt � Yes � No How Determined Total Amou � <br /> RESOURCEFEE ERU <br /> TOTALAMOUNT � <br /> Prepared By Checked �y <br /> NO CERTIFICA7E OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTiI, THE TOTAL AMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMITI'IN(3 OFFICE OF PASCO COUNTY <br /> Acknowledgemant below does not Imply acceptance of concurrenoe, but simply recelpt of a copy of thls form, placing <br /> ihe buliding permit owner on notice of ihls assessmenl and the condlllons of payment for same. <br /> QATE R�CEIVED BY <br /> RECEIPT NO DATE By <br />