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� <br /> , ��;r� <br /> ,� <br /> �r�r�, <br /> •, <br /> �. <br /> .,; : <br /> : t�ASCC� fJ��1TYy FLC�i�ID,r4 <br /> � <br /> � * Permit No. �.�9�/� <br /> , <br /> Date Permitted �—�f� ` <br /> Buiider Name/Owner Name ��i I � �+-�"�tG , ��ontra!# <br /> County Parcel No. � �� 2�-�, _p ((3�4�cX�--0( 2-o SubDiv: �I�[����, <br /> P�.��;�, <br /> Address/Location c� � ��'`t' �� �� � <br /> � <br /> Classification/Type of Use ��r.t� vtt��... <br /> TRANSPORTATION IMPACT FEE Rate: Sq Ft Unit: ��..._...._ � <br /> Exempt � Yes [] No How etermined i <br /> � Impact Fee Amount $�� �Q p � Zo�e No. TAZ: <br /> SCHQO� IMPACT FEE <br /> Account {Q56) Single-Family Det ched Hause Amount $ �� <br /> (057} Mobile Hflme �� <br /> (Q58} Other ResEdentia! <br /> 123) Co!lection Fee <br /> Exempt Yes [� No Haw etermined <br /> PARKS AND RECREATION FEE <br /> Land Account Land redlt Land Tota! <br /> Recreation Account R creation Credit Recreatian Tota! <br /> Zone T�TAL AMOUNT $ rT/�J ��_ <br /> Exempt [� Yes [� No Haw etermined <br /> LIBRARY FEE <br /> Land Accaunt Land redit Land Total <br /> Facility Account Facilit Credi# Faciiity Total <br /> Exempt [� Yes ❑ Na Haw etermined Total Amount ,��� <br /> RESOURCE FEE ERU <br /> TOTAL AMOUNT <br /> Prepared By o Checked By <br /> NQ CERTEFlCATE OF aGCUP NcY WIL� �E isSUEE� OR FINA� iNSPECTION <br /> PERFORIUIED UNTIE� HE 7{�TA�. AMOUNTS LISTED HAVE <br /> BEEN PAID AND <br /> RECEIPTED FOR BY A GENT AL PERMlTTING O�ElGE OF PASCQ COUNTY <br /> Acknowledgement below does not imply accep nce of concurrence,but simply recaipt of a capy of this farm,placing <br /> the building permit owner on natice f this assessment and the condifions of payment for same. <br /> DATE RECEfVED BY � <br /> RECElPT NO. DATE BY <br />