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� ` PASCU COUNTY, �'LORIDA <br /> Permit No. � b <br /> Date Permlttad �� <br /> Builder Name/Owner Name �� �� (` � 1'1'(E'� Control # <br /> County Pa[ce! No. �� �j -�-- � W Q-. �ld.� ' I ���`�s�� _ <br /> _ r/� <br /> AddresslLocation �.,.3 � , � �' � �'l° •z� � �6 <br /> Classificatlon/Type of Use ((� C,R�(l Y IC�� <br /> TRANSPORTATION (MPA�T FEE , Rate: Sq Ft Unit: f ��d j <br /> Exempt � Yes � No HoW Determined <br /> � Impact Fee Amount $ ���d � Zone No. TqZ; <br /> SCHOOL iMPACT FEE <br /> Account (056) Singte-Family Detached House Amount $_ j,�] J 7. � U <br /> (057) Mobile Home -- <br /> (058) Other Residential <br /> 123) Collection Fee <br /> Exempt Yes [] No How Determfned <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account _�_ Rec�eation Credlt Recreation Total <br /> Zone TOTAL AW�OUNT $ �_ '� �c� �! <br /> ! - 1� <br /> Exempt � Yes [] No How Determined � <br /> LIBRARY FEE <br /> l.and Account Land Credit <br /> Land Total <br /> Facility Account __�_ Facflity Credit <br /> Facility Total <br /> Exempt [] Yes [] No How Determined <br /> ___ Totai Amount � <br /> RESOURCE FEE <br /> TOTAL AMOUNT ERU <br /> Prepared By � � � <br /> Checked Sy <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTiON <br /> PERFORMED UNTIL 7HE TOTAL qMOUNTS LISTED HAVE <br /> RECEIPTED FOR BY q CENTRAL ERMITi' NG OFFICE OF PqSCO COUNTY <br /> Acknowledgement below daea not Impiy acceptance of co�currenoe, but slmply recelpt of a copy of thls form, plaoing <br /> Ihe building permlt owner on noUce oi thls assessment and th� conditions pf paymen! for seme. <br /> �ATE <br /> R�CEIVEQ BY <br /> RECEIPT NO. _�_ pATE <br /> �_ BY <br />