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Name (First, Ml, Last) <br />CITY OF SANTA ANA <br />Planning and Building A ency <br />Certificate of Compliance A2Dgj <br />Payment of School Facility Fees Apprd <br />Santa Ana Unified School District FOR PERMIT ISSUANC <br />Telephone Date <br />Project Address <br />q 19 N µRu:ss e 11 Aye <br />City, State, Zip Code <br />onfa Ana, CA 92404 <br />Name (First, MI, Last) <br />Tract/Parcel Number <br />10 112 30 2.9 <br />Telephone <br />Use of Building check) Type of Project (check) <br />Residential E Commercial ❑ Senior Housing ❑ New 9 Addition ❑ Alteration <br />Description of Project <br />Con"Vert Stood ciarclge A acld PSO sf ire AIDU <br />Number of Square Feet of <br />Residential Space 610 <br />Number of Square Feet of <br />Commercial Space <br />Sq.Ft x $ 5.1 <br />(Dev. Fee) <br />Sq.Ft x $ <br />(Dev. Fee) <br />Total $ 2, to Z (V o10 <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 shallautomatically 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 />CLOC,let V&C'11 10;�r <br />Applicant Nance (Please Print) Date <br />Signature <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 AndJUnified School <br />Authorized Representative <br />1A(Z1V2S— <br />Date <br />DISTRIBUTION <br />White - City/County <br />Canary - Applicant <br />Pink - Facilities <br />