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SphSA `*V <br />H00-�`S� <br />Certificate of Compliance <br />Payment of School Facility Fees <br />Santa Ana Unified School District <br />CITY OF SANTA ANA <br />Planning and Building Agency <br />5126 <br />Approved <br />FOR PERMIT ISSUANCE <br />Name (Firs MI, Last) -Telephone Master ID: <br />�� �.. A <br />Project Address Tract/Parcel Number <br />C( State, Zip Code \ � ' <br />Jt'\1Y l J� 1 ' <br />Name (First, MI, Last) I Telephone <br />Use of Building (check) Type of Project (check) <br />Residential Commercial ❑ Senior Housing ❑ Ne\(V Addition ❑ Alteration ❑ <br />Description of Project <br />Number of Square Feet of 1 <br />Residential Space ` Sq.Ft x $ Total S l� <br />(Dev. Fee) <br />Number of Square Feet of <br />Commercial Space <br />Sq.Ft x $ <br />(Dev. Fee) <br />Total $ <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 />Govejnmr,nt Code Section 53080 must do so within 90 days from the payment of the fee. <br />Applicant Name (Please Print) Date <br />Signature <br />This certifies that the above -named Applicant has paid school facility fees in compliance with all existing and applicable <br />sections of the Government Code and Education Code. <br />DA� ( �M'k oy- P I (A V1 rV_11 -j ZS <br />Sant na Unified School District Authorized Representative ate <br />DISTRIBUTION <br />While - Cily/Counry <br />Canary - Applicant <br />Pink - Facilities <br />