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, ' <br /> P°�4 �� ��l��Vl'Yy FLOF�I�A <br /> Permif No. 1 J u• cC j <br /> Dake Permitted ��y-� <br /> � - _/r�� . <br /> 8uikder NamelOwner IVame �� �' �L13'l.��Ctc y�j1 '�L-15.;anfrol# <br /> Caunty Parcel Na ��- - --bZ(� -- ` ��(jyC�ubDiv; �/a/`tLL�� <br /> AddresslLocation ? ?5 G^tf�^���. �,i;�,S� �i / 7-'� <br /> Ciassi�cationlType of Use �-S j�C:�',�,`h� �� �4l)lti�1f7�., <br /> TRA�lSPORTATION IMPAC FEE Rate: 5q Ft Unit: t ��1 � <br /> Exempt � Yes [] No How Determined <br /> Impact Fee Amount $ �3 c�:�b ' Zone No. TAZ: <br />� SCHOOL IMPACT FEE <br /> Account (056) Single-F mily Detached House Amount $ � <br /> {057} Moblle H me <br /> (058) Other Re idential <br /> 123� Collectio F�e � <br /> Exemp# � Yes � Na Now De#ermined <br /> PARKS AN[3 RECREA7IQ� E� <br /> tand Account Land Credit Land Total <br /> i Recreation Accotan# Recreation Credit Recreafion Total <br />� <br /> Zone TOTAL AMOUNT $ '7��s � <br />�� Exempt � Yes [� No How Determined <br /> Ii <br /> LIBRARY FEE <br /> Land Accaunk Land Credit l.and Tota! <br /> Facility Account Facillty Credit Facility Total <br /> i Exempt � Yes ❑ No How Determined Total Amount -(�'" <br /> RESOURCE FEE ERt} <br /> TOTAL AMOUNT <br /> Prepared By �� Checked By <br /> PIO CERTIFIGATE OF GCUPANCY WILL BE ISSUED�E2 FlNAL INSPEGTION <br /> PEFtFCii2iVflE UhITI�TFtE TO7AL AMOUNTS I.ISTED HAVE <br /> BEEN PAID AND <br /> RECElPT�.D FOft BY CEtdTEtAL PERMITTlNG C:OFFICE OF PASGO CUUNTY <br /> Acknowiedgement betow does not i ply acceptance of concurrence,but simpty receipt of a capy ot this farm,ptactng <br /> fhe building permit owner n notice of thls assessmenf and the conditians of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO. DATE BY <br />