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. . , ; �'A �� �OIJNT'Y, FLO�I�A <br /> Permit No. �,5�� <br /> ,1 ^ Date Permitted -�� <br /> Buiider NamelOwner Name ¢�-�"�`���f �I"���'.�%�� Control# <br /> �_' <br /> County Parcel Na. C�"Z "��-�'� 1 a'�'U[:CG-C-3�J SubDiv: L�i,[i��rLc`kG'p�i�. <br /> 1 <br /> Address/Location .3 7 7•. �� 1"j�u.��'��C. �--�'�"- � � <br /> Classi�cationtType of Use �!�,�r`1. �1�}'Y� <br /> TRANS�ORTATIC3N IMPA T FEE Rate: Sq Ft Uni#: �C.'Z � <br /> Exempt [� Yes [] No How Determined <br /> Impact Fee Amount $ �.� ��' Zone No. TAZ: <br /> SCHOO�IMPAGT FEE --�./ <br /> Account (058) Single- amily Detached Mouse Amount $ �% <br /> (057} Mabile ome <br /> (058) Other esidential <br /> 123) Collecti n Fee <br /> Exempt Yes [� No How Determined <br /> PARKS AND REGREA710 FEE <br /> Land Account Land Credit Land Total <br /> Recreation Accaunt Recreation Credit Recreation Totai <br /> Zane TOl"AL AMOUNT $ ��(--r�. <br /> Exempt [] Yes [� No How Determined <br /> LIBRARY FEE <br /> Land Account Land Credit �and Tatal <br /> Facility Account Facility Credit Facility'fatal <br /> Exempt [� Yes � N How Determined Total AmounE �-'��� <br /> RESOURCE FEE ERU <br /> TOTALAMOUNT <br /> Prepared By � .:1--� Checked By <br /> 9�0 CER7tFtGATE F OCGUPANCY W1LL 8E lSSUED OR FINA�.4NSPECTION <br /> PERFOR ED Ui�T1L.THE 7dTRL AMOUNTS LiSTEd HAVE <br /> BEEN PAID AND <br /> REGElP7E4 FC}t2 A GENTF2AL PERMIT"fitdG OFFiCE QF PASCQ COUNTY <br /> , Acknowledgement belaw does n t Etnply acceptance of cancurrence,but simpiy recslpf of a copy af this form,ptacfng <br /> i the bui�ding permit ow er on notica of this assessment and ther conditians of payment for same. <br /> � <br /> DATE RECEIVED BY <br /> RECEIPT NO DATE BY <br />