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SaNTA q'Y4 <br />CITY OF SANTA AN <br />Planning and Building Agency <br />Napie (First, MI, <br />Project Address <br />State, Zip Code <br />Name (First, Ml, Last) <br />Certificate of Compliance <br />Payment of School Facility Fees <br />Santa Ana Unified School District FOR <br />Building <br />a <br />TelephoneDate: <br />1O_ <br />TracUParcel Number <br />Telephone <br />AppAJ@V <br />PERMIT ISSUANCE <br />Use of Building (check) Type of Project (check) <br />Resident Commercial ❑ Senior Housing ❑ NeQ Addition ❑ Alteration ❑ <br />Description of Project <br />Number of Square Feet of r �� <br />Residential Space Sq.Ft x $ \ Total $ <br />(Dev. Fee) <br />Number of Square Feet of <br />Commercial Space <br />Sq.Ft x $ <br />(Dev. Fee) <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 />Applicant Name (ea(Oea6 Print) Date <br />Signatu e <br />This certifies that the above -named Applicant has paid school facility fees in compliance with all existing and applicable <br />sections of the Governme Code and Education Code. <br />C <br />Santa An ified School District Aut orized Representative Date <br />DISTRIBUTION <br />White - City/County <br />Canary - Applicant <br />Pink - Facilities <br />