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CITY OF SANTA ANA <br />Inning and Building Aqen <br />SpHTA 4 <br />c ' r <br />Z <br />S�H00�� <br />Certificate of Compliance <br />Payment of School Facility Fees <br />Santa Ana Unified School District <br />Ap <br />FOR PERMSURNCE <br />Date: <br />Name (First, \11, I.ast) Telephone <br />Project Address 10 "Tract/Parcel Numher <br />JL-�q_ _ n _VUXI <br />City, Ste. Zip Code <br />Y <br />Name (First, ML Last) Telephone <br />I <br />n �,a <br />Use of Building (check) Type of Project (check) <br />ResidentiaCk Commercial ❑ Senior Housing ❑ Ne4 Addition ❑ Alteration ❑ <br />Description of Project a ) e <br />N�1'I . I—,.r n ry ,. n ir-c,Nf\/1 r . rlM IA-1 non <br />Number of Square Feet of _ <br />Residential Space Sq.Ft x $ <br />(Dev. Fee) <br />Number of Square Feet of <br />Commercial Space <br />Sq.Ft x $ <br />(Dev. Fee) <br />Total $ v <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 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 />Govern ent Code Section 53080 must do so within 90 days from the payment of the fee. <br />Applicant Name (Please Print) Date <br />Sibnature <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 />Y1 V1R� <br />Santa A a I died aScoolDistrict Authorized RepresentativeV Date <br />DISTRIBUT/OA' <br />White - CinllCounty <br />Canary - Applicant <br />Pink - Facilities <br />