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NA <br />13ul ncy <br />SpNTA A,r4 <br />Certificate of om CBanc a►� <br />�^ � 11 ji 4 10 1 1 <br />Payment of School Facility Fees <br />.�� ,.,.��......,Q.Ci ilkdill <br />rrrriSCHO Santa Ana Unified School District�N� <br />elep one Ma <br />ast)_THAGo D Jt6 <br />C,�ame First,om, � ID <br />o owl <br />AL <br />ract/Parcel m er <br />poct Addressj�PP <br />,State, Zip Code <br />Name (First, MI, Last) Telephone <br />Use o Building (check) Type of Project (check) <br />Residentia61 <br />l ❑ Commercial ❑ Senior Housing ❑ New ❑ Addition ❑ Alteration ❑ <br />D Cnption o roject <br />Number of Square Fee i <br />Residential Space Sq. Ft x $ � Total $ <br />Dev. Fee) <br />Number of Square Feet of <br />Commercial Space S 401 t x $ Total $ <br />Dev. Fee) <br />The above representations as to square footage are true. Applicant agrees that if it is later deterniined that such <br />representations are not true, then this certificate shall automatically terminate, and the appropriate City/County shall be <br />In <br />notified. Applicant is hereby noticed that any party filing a protest regarding the it,position of fees pursuant to <br />ovenunent Code Section 3080 must do so within 90 days from the payment of the fee. <br />ION <br />1 - V f Ck V1 0 <br />Applicant Name (Please Print) Date <br />Signature Nov <br />This certifies that the above -named Applicant has paid school factoli'l <br />ty fees in compliance with all existing and applicable <br />sections o the Gove e-%nt Code and Education Code. <br />Santa Ana I ie chool District Authorized Representative Date <br />DISTRIBrjTION <br />White - Ci oill <br />Canary -Applicant <br />Pink, - Facilities <br />