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;� , : PA�CO COUNTY, FLORIDA <br /> Permit No. �Z <br /> Date Permitted = % ^ <br /> Builder Name/Owner Name � n�� r[�' `�S � Control # <br /> � � DSubDiv: � ' GC� �''�`��� <br /> Counry Pat'cel No. b �J - 2� —v��D--���`� <br /> Address/Location � 1 � �P � � 'T�Ti � C �-1 n � '" ��� � �� $ <br /> Classification/Type of Use� .1�� � � ✓ <br /> TRANSPORTATION IMPACT FEE . Rate: Sq Ft Unit: � <br /> Exempt � Yes [� No HoW Determined <br /> Impact Fee Amount $ J'C U O Zon,e No. TAZ: <br /> SCHOOL IMPACT FEE ^-� - (� <br /> Account (056) Single-Family Detached House Amount $ � !� / ' �" � <br /> (057) Mobile Home <br /> (058) Other Residential <br /> 123) Collection Fee <br /> Exempt [�] Yes Q No How Determined <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Rec�eation Credit Recreation Total <br /> Zone � TOTAL AMOUNT $ 7�j � • �� <br /> Exempt ❑ Yes � No How Determined <br /> LIBRARY F�E <br /> �and Account Land Credit Land Total <br /> Facility Account Facillty Credit Facility Total <br /> Exempt � Yes � No How Determined Total Amount v <br /> RESOURCEFEE ERU � <br /> TOTALAMOUNT � <br /> Prepared By r Checked Sy <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTION <br /> PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY q CENTRAL PERMITTIN(3 OFFICE OF PASCO COUNTY <br /> Acknowledgement below does not Impiy acceptence of concurrenpe, but simply recelpt of e copy of thls form, placing <br /> Ihe building permit owner on notice of this assessment and tha condilions of paymenl for seme. <br /> DATE R�CEIVED BY <br /> RECEIPT NO DATE gY <br />