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; <br /> • � � � P'A C� Ct�lJNTY, FL{��tDA <br /> Permit No. ! 5 E;�1 <br /> Date Permi#ked � - � -� <br /> B�ilder NamelQwner Name A 1--L r�Q�I+D1`� �Q+UJr��7uPEControl# <br /> County Parcel No. �'{ - 2S'-'Z-i - 4 tS�� -c'�,ipup-32YoSubDiv: GrQr,p' ({��tZ�fuS <br /> Address/�ocatian � (,� �a{tt _w�� /�we 3�t{ ¢ �g <br /> Classification/Type of Use ' � l�'',;��'��p,� ' ' <br /> TRANSPORTATION IMAAC FEE Rate: Sq Ft Unit: � � �i� <br /> Exempt � Yes � Na How Determined <br /> lmpact Fee Amount $ �3�-'�� Zane No. TAZ: <br /> SGHdOL IMPACT FEE <br /> Account (056) Single-Fa ily Detached Mouse Amount $ _ __� <br /> (057} Mobile Fi me <br /> (058) Qther Re idsntial <br /> 123) Collectlon Fee <br /> Exempt [�] Yes [� Na How Determined <br /> PARKS AND RECREA'flGth! EE <br /> Land Account Land Credik Land Tota! <br /> Recrea#ian Account Recreation Gredit Recreation Total <br /> Zone TOTAL RMOUN7 $ �7 3. 7� <br /> Exempt [] Yes [� tVa How Determined <br /> LIBRARY FEE <br /> Land Account Land Credit � Land Total <br /> Facility Account Facility Credit Facility Totat <br /> Exempt [] Yes � Na How Determined Tota!Amaunt __`"�� <br /> RESOURCEFEE ERU <br /> TOTALAMOUNT <br /> Prepared By _� _ Checked By <br /> NQ CERTIFIGATE OF CCUPANCY WILL BE ISSUEp 012 FINAL lNSPECTION <br /> PERFC)RC1flE UNTIL THE 70TAL AMOUNYS LISTED HAVE <br /> BEEN FAID AND <br /> REC�IPTED FQR BY CEtJ1'RAI.PERMITTlNG OFFIGE OF PASGO COUNTf <br /> Acknowledgement befow does nok Im ly acceptance of cancurrence,but slmpiy recelpt of a copy of this form,p{acing <br /> the building parmit owner n notice of this assessment and the conditions of payment for same. <br /> DATE RECEIVED BY <br /> RECEIPT NO DATE BY <br />