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CITY OF SANTA ANA <br />Planning and Building Agency I <br />sCHO& <br />Name (First, MI, Last) <br />Project _Address <br />City, State. Zip Code <br />Name (First, MI. Last) <br />Certificate of Compliance <br />Payment of School Facility Fees <br />Santa Ana Unified School District <br />C (�� 7: G*111� <br />Use of Building (check) <br />Residential El Commercial El Senior Housing El <br />Description of Project <br />N \ P�Ac )c <br />Number of Square Feet C <br />f <br />Residential Space Sq.Ft x <br />Number of Square Feet of <br />Commercial Space Sq.Ft x <br />Telephone <br />App5�rovO9dl <br />FOR PERMIT ISSUANCE <br />== - f <br />Master I D. . P F G OLD E N CI <br />_)UNDED 7869 <br />D CITY y <br />• <br />Tract/Parcel NuiYiher <br />Telephone <br />Type of Project (check) <br />New[] Ad(fitionO Alteration[] <br />(Dev. Fee) <br />(Dev. Fee) <br />Total Sa <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 ternlinate, and the appropriate City/Cou11ty shall be <br />notified. Applicant is hereby noticed that any party filing a protest regarding the iniposition of fees pursuant to <br />Government Code Section 53080 must do so within 90 days from the payment of the fee. <br />Applicant Name (Please Print) D e <br />Signature <br />This certifies that the above -named Applicant has paid school facility fees in compliance with all existing and applicable <br />!ntative <br />DISTRIBUTION <br />WhUe - CityCounn, <br />Canary - AlphCant <br />Pink • 1 iicil aces <br />� 2z 25 <br />Hate <br />