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Certificate of Compliance <br />Payment of School Facility Fees <br />Santa Ana Unified School DI <br />str1 <br />ct <br />3uflding C <br />Name (First, MI, Last) <br />0, <br />t Address <br />State, Zip Code <br />'hlY1G <br />I rIF: <br />Name (first, MI, Last) <br />Use of Building (check) <br />Residentiaf( & Commercial ❑ Senior Housing ❑ <br />Description of Project <br />Number of Square Feet o <br />Residential Space <br />f, <br />Telephone <br />1 ��0 <br />CITY OF SANTA ANA <br />Planning" and Building Agency <br />506! <br />pproved <br />1111111MIT ISSUAN <br />Master ID: <br />I t <br />99�%ftv__ft C I <br />Tract/Parcel Number <br />Tclepliotle <br />umagam -- = - - M <br />Type of Project (clieck) <br />Sq.Ft x $ S ., <br />(Dev. Fee) <br />Number of Square Feet of <br />Commercial Space Sq.F <br />t x $ <br />(Dev. Fee) <br />Ne%N1ZA, Additi-on ❑ Alteration ❑ <br />Total S 10,, () 1� . <br />Ll <br />Total S <br />The above representations as to square footage are true. Applicant agrees that if it is later determined that such <br />representations are not true, then this certificate shall automatically terminate, and the appropriate City/County shall be <br />notified. Applicant is hereby noticed that any party filing a protest regarding the imposition of fees pursuant to <br />Government Code Section 53080 must do so within 90 days from the payment of the fee. <br />1 <br />I tD " <br />Applicant <br />Signature <br />Name (PleasePrint) <br />This certifies that the above -named Applicant has paid s <br />sectiqpsmafAke Government Code and Education Code. <br />Sant�a,Ana U WScI1001, <br />DISTRIBUT70A' <br />White • CirylCounry <br />Canary - Applicant <br />Pink - Faculties <br />21; <br />D a tce <br />zS <br />chool facility fees in compliance with all existing and applicable <br />strict Authof ized Representative <br />NIMOW94 I "Noftfto <br />Date <br />