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' �` � P'A��� COt��tTY, ��.�RI�A <br /> Permit Na. �.�d 7 <br /> Date Permit ed - _7� <br /> Builder Name/Owner Name _��L{�e.�i.� /�i�it Control# <br /> Caunty Parcel Na. ��-�o-�-�G�- Q(p(�,QO- 7X}D(� SubDiv: ��th�t-� r�itK'../D�c��+�Yrn <br /> AddresslLoeation ����.5�i �Y�tr!`t� �� f� �� �., <br /> Classification/Type of Use dL`Ur�1��ry <br /> -�-ar� ; ��y� <br /> TRANSPORTATION IMPACT FEE Rate: Sq Ft Uni ��,_p�,��, �' <br /> Exempt � Yes � �!o Flow Determined <br /> impact Fee Amaunt $ J���• C�} Zone No. TAZ: <br /> SCHOOI.IMPACT FEE , <br /> Account {d56} Single-Famity Detached House Amount $ ��',.�-/ <br /> �� (05'7) Mobile Home <br /> {058) Other Residentiai <br /> '123) Collecfion Fee <br /> Exempt Yes [� No How Determined <br /> PARKS AND RECREA710N FEE <br /> Land Account Land Credit Land Tota! <br />�I <br /> i Recreation Accaunt Recreation Credit Recreation Total <br /> Zane . <br /> TO7AL AMOUNT $ `7��f'' b� <br /> '� Exempt � Yes [� No How Determinsd <br /> LIBRARY FEE <br /> �and Acco�n# Land Credit L.and Total <br /> Facility Account Facility Credit Facility Total <br /> Exempt ❑ Yes [] No How Determined Total Amount /"+� <br /> RESOURCEFEE ERU <br /> TC7TAL AMOUNT <br /> Prepared By r Checked By <br /> NO CERI'IFiCA7E OF dCCUPANCY WtlL BE 1SSUEd OFi FiNAL{i�SPECTtON <br /> PERFdRMED UNTIL THE 70TAL AMOUNTS LISTED HAVE <br /> SEEN PA1Q ANd <br /> RECEIPTED FOF2 BY A CEt1TF2AL PERMITTING d�FICE OF PASCO COUNI'Y <br /> Acknowiedgement below does not impiy acceptance of concurrence,but simply rece�pt of a copy af this form,placing <br /> the building permit owner on notice of lhis assessment and the conditians of payment for same. <br /> DATE RECENED BY <br /> R�CEIPT NO. DATE BY <br />