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�s: <br /> � < <br /> � � �� �r� ������� ��.����� <br /> �� <br /> Permit No. `��.3�� . <br /> Date Permitted .�-z� _ �l/-/5�' <br /> Builder NamelOwner M1lame �����/Gt �GM•S�C�J�r� Control# <br /> County Parce!No. �� �= Z ._-d j '.�c,-(`�t��(}-OU3t� SubDiv: ���yT �Oyvtrr��S <br /> Address/Location l�� �S�A-� �� � <br /> ClassificatiaNType of Use ,��e,-ci c - ��, � <br /> TRANSPLIRTATION iMPAC FEE Rate: Sq Ft Unit: t 1 /t� / <br /> Exempt � Yss � No Naw C}etermined <br /> Impact Fee Amount $ (��.fp? Zone No. TAZ: <br /> SCHOOLIMPACTFEE <br /> Account (Q56} Single-F mily Detached Fiouse Amount $ .,-�� <br /> (057} Mobile ome <br /> (058) Other R sidential <br /> 123} Collectio Fee <br /> Exempt Yes � No How Determined <br /> PARKS AND RECFtEAT10 FEE <br /> Land Account Land Credit Land Total <br /> Recreation Account Recreation Credik Recreation Total <br /> Zone TC?7AL AMOUNT $ �'' <br /> Exempt [� Yes [� No How Determined <br /> LIBRARY FEE <br /> �and Account �and Credif t�and Total <br /> Facility Account Facility Credit Facility To#al <br /> Exempt [� Yes [� No How Determined `fotal Amount —�'� <br /> � RESdURCE FEE ERU <br /> T07ALAMOUNT <br /> Prspared 8y Checked By <br /> Nt?CERTIFICATE t7CCUPANCY WIL�BE ISSUED Of2 FiNA�INSPEGTIQRi <br /> PERFORM D UNTIL THE'TOTAL AMOUNTS LISTED H�VE <br /> BEEN PAID AND <br /> E2�GEIP7ED FC1R B A CENTl2Al.P�RMITTING{3FF10E CDF PASCO COUNTY <br /> Acknowledgement beiow daes n lmply acceptance of concurrence,bat simply receipt of a copy of tfiis form,plactng <br /> Rhe building permit ow er on noQce a(this assessmenk and thp conditions of payment for same. <br /> DATE ftEGEfVEd SY <br /> RECEIPT NO DATE BY <br /> I � - <br /> L_ __ <br />