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,� PA�CO COUNTY, FLORIDA <br /> • Permit No, ��i� <br /> Date Permitted <br /> Builder Name/Owner Name (/VG�( �Cf ' `�'�Cf""`���rol# <br /> County Parcel No. (�� --Z�—Z�—�v10-1�3`Idd'C7�3a SubDiv: <br /> Address/Location 3� � 3� �""'"��� `�,u� �� <br /> Classification/Type of Us@ C'dmMe�'C��r�' AM!�S ���' �l `�''��� �� L�jt�� <br /> TRANSPORTATION IMPACT FEE � Rate: Sq Ft Unit; (2i �z�, <br /> Exempt ❑ Yes � No HoW Determinsd <br /> Impact Fee Amount $ /�� ,��j�/. � � Zone No. TAZ: <br /> SCHOOL IMPACT FEE <br /> Account (056) Single-Family Detached House Amount $ ^ ��� <br /> (057) Mobile Home <br /> (058) Other Residentlal <br /> 123) Collectio�Fee <br /> Exempt � Yes [] No How Determined <br /> PARKS AND RECREATION FEE <br /> Land Account Land Credit Land Tota) <br /> Recreation Account Recreation Credit Recreation Total <br /> Zone TOTAL AMOUNT $ /��� <br /> Exempt � Yes � No How Determined <br /> LIBRARY FEE <br /> �and Account Land Credit Land Total <br /> Facility Account Facllity Credit Facility Total <br /> Exempt [] Yes � No How Determined Total Amount /�� , <br /> RESOURCEFEE ERU <br /> TOTAL AMOUNT � <br /> Prepared By Checked Sy <br /> NO CERTIFICATE OF OCCUPANCY WILL BE ISSUED OR FINAL INSPECTIpN <br /> PERFORMED UNTIL THE TOTAL AMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A CENTRAL PERMITTING OFFICE OF PASCO COUNTY <br /> Acknowledgement below does not Imply acceptance of concurrenGe,but simply recelpt of a copy of this form,placing <br /> the building permit ownei on notice of this assessment and lha conditions af payment for same. <br /> RATE R�CEIVEp BY <br /> RECEIPT NO DATE BY <br />