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Garden Grove Unified School District <br />Certification of Compliance <br />Payment of School Facility Fees <br />Developer/Applicant <br />CITY OF SANTA ANA <br />Planning and Building Agency <br />No. R429 <br />pproved <br />FOR PERMIT ISSUANCE <br />Master ID: <br />Address W-1 �% c�7� a t h f DDv-3,a ti <br />Telephone Number ((p5�) TOO ?j1-71 <br />Project Location ` a.S b#Wi <br />Street Address City ZIP <br />Elem. School Int <br />High School Thomas Map No. <br />----------------------------------------------------------------------- <br />Number of Square Feet <br />of Residential Space <br />1,00 <br />Number of Square Feet / <br />of Commercial and <br />Industrial Space / X <br />Total $ <br />Total $ <br />The above representations as to square footage are true. Developer/Applicant agrees that if it is <br />later determined that such representations are not true then this certificate shall automatically <br />terminate and the appropriate City/County shall be notified. <br />Applicant is hereby noticed that any party filing a protest regarding the imposition of fees <br />pursuant to Government Code Section 65995 and Education Code Section 17620 must do so <br />within 90 days from the payment of the fee. <br />Date Developer/Applicant <br />Receipt of Payment <br />This certifies that the above -named Developer/Applicant has paid school facility fees in <br />compliance with Government Code Section 65995 and Education Code Section 17620. <br />These fee have been received from F l7 {-W,I �_ '�ti1'fL 120!Lf � qQ V kffil IAC <br />�� bne hundrrl 5�,,�eik 4yla '0/[()() Dollars $ 5, i♦� <br />Cash Check ✓ Check No. Bank CJ\ V_) <br />ate' Superintendent Designee <br />Garden Grove Unified School District <br />(714) 663-6442 <br />9703.69' (Rev. 6/14) <br />