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SpHTA A�4 <br />�\ � <br />N00��`S� <br />NalZe (First, MI, Last) <br />Certificate of Compliance <br />Payment of School Facility Fees <br />Santa Ana Unified School District <br />Project Address <br />X\L� \i"I Auy�00K- <br />City, State, Zip Code,, <br />Name (First, MI, Last) <br />Use of Building (check) <br />ResidentiSgi� Commercial ❑ Senior Housing ❑ <br />Description of Proj <br />Number of Square Feet of <br />� <br />Residential Space <br />Number of Square Feet of <br />Commercial Space <br />Telephone <br />CITY OF-5*,f hTA ANA <br />Planning and Building Agency <br />App?%1?t? <br />FOR PERMIT ISSUANCE <br />Mast__I a.: _ <br />Date: <br />Tract/Parcel Number <br />Telephone <br />Type of Project (check) <br />NeSX Addition ❑ Alteration ❑ <br />Sq. Ft x S 11r � \ <br />(Dev. Fee) <br />Sq.Ft x S <br />(Dev. Fee) <br />Total $ <br />LA I\. <br />, Zko <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 />T/1141- I'I , T',/'vrultV to )- s <br />Appl ant Name (Please Print) bate <br />/gZnature <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 />AWVd4/U(�M1C'V--' DAVNOZ't�) �/g 12-��— <br />Santa Aha Unified School District Authorized Representative Date <br />DISTRIBUTION <br />While - Clt')-XouwY <br />Canon_ . - Applicant <br />Pink -Facilities <br />