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CITY OF SANTA ANA <br />Certificate of Compliance <br />Payment of School Facility Fees <br />Santa, Ana Unified School District <br />cmirr M 10=11, <br />Name (First, MI, Last) <br />ry)�� � <br />Project Address Lract/parcel Number <br />h 1313 N a S puvcl eck) Ef . I o I I 2 2 <br />Planning and Building Agency I <br />FOR PERMIT ISSUANCE <br />Cit)r, State, Zip Code <br />VY) <br />I C I ly"11 I (I J <br />U � T <br />Nanic Nit, Last) <br />Use of Building (check) <br />('I$hobri <br />u <br />1]11UN01i/: <br />L <br />• <br />Tel phone <br />3z3 <br />Telephone <br />O-V <br />Type of Project (check <br />� <br />Residential Commercial Senior Housing ❑ <br />Description of Project co y) V e ir t- C8� CJ U � � C) es <br />A dU''S <br />41 <br />Number of Square Feet of <br />Residential Space <br />Sq.Ft x $ 50 1 �7 <br />(Dev. Fee) <br />Number of Square Feet of <br />Commercial Space Sq,Ft x $ <br />(Dev. Fee) <br />.ter 1 <br />L4 --rq <br />�..mp. <br />,!! � <br />I1"Tiaster-t-D:GOLDEN <br />OUNDED 1869 <br />yr e: <br />New ❑ Addition ❑ Alteration <br />(s000 i i f f qe Q C h ) fC' VJ e LA/ <br />Total S;� I � 3S 31,r iZ, <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 />Appiicani name ease rrint) <br />Signature <br />/%one�=z6 <br />Date <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 />Santa <br />1 <br />"n n P, 0 ( I 61 <br />W V 1%ftwow- 46 1 Moe 1 <br />a Unified School DstfictiAuthorized Ilepresentative <br />DISTRIBUTION <br />N'hiie - Cityl(."ounty <br />Canary • Applicant <br />fink - Facilifies <br />Date <br />----------------------------- <br />Scanned with <br />CamScanner :: <br />----------------------------= <br />