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' � � � : �.A �C� �C�l��1TY, FLORI�`A <br />, .. . Permit Na. �J�� <br />� Date Permitted _..�(� <br />� Suiider NamelOwner Name �� � <br /> C." �'�2`N a � t-C.�Gonfrol# <br /> Caunty Parcel Na. S ; --��1:�—�G(�.. +� ) SubDiv: �-a j—�- y� =�'j,� <br /> Address/Lacation 3 7 7• .`�� ' I'�<<�"�� �(;�� � <br /> ClassificatiantType of Use ; ) yt��"Yr�;_ <br /> TRANSPORTA7'!ON iMPAC FEE Rate: Sq Ft Unit: �' G��7 <br /> ___�_.__ <br /> Exempt � Yes � No . How Determined <br />�' Impact Fee Amount $ �� �f� Zone No. TAZ: <br />' <br />, SCNOOL IMPACT FEE <br /> Account (056) Single-F mily Detached House Amount $ _��'""'� <br /> {057} MobiEe ome <br />' (058} Other R sidentiai <br /> 123) Colleekio Fee <br />' Exempt [� Yes [� No How Determined <br />; PARO{S AND REGREAT101� FEE <br /> Land Account Land Credit Land Total <br /> Recreatian Account Recreation Credit Recreation Totai <br /> Zone TOTAL AMOUNT $ 7��° �� <br /> Exempt � Yes [� No How Determined <br /> l <br /> ' LIBRARY FEE <br /> Land Account Land Credit Land Tatai <br /> Facility Account Facility Credit Facility Tatal <br /> Exempt [� Yes ❑ No How petermined Total Amountt`���_ <br /> ' RESdURCE FEE ERU <br /> ' TOTALAMOUNT <br /> � Prepared By � Checked By <br /> ' NQ GERTlFICATE O OGCUPANCY VUILL BE ISSUED OR FlNd1�.1�4SPECTiOf� <br /> � PERFt)RM D iJNTIi.TFlE TO'TAL AM011NTS IISTED HAVE <br /> , BEEN PAID AND <br /> RECEtPTED FOR B A CENI'RAL P�RMIT7IMG OFFICE OF PASCQ CC�UNTY <br /> Acknawtedgement beiow does no Imply accsptancs of concurrenca,but simply recelpt af a copy of this farm,ptactng <br /> � the buiiding permit aw r on notice of ifiis assessmant and th�conditians of payment for same. <br /> ' DA7E RECElVED BY <br /> RECEIPT NO. DATE BY <br />