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C1TNY,,08§ffTA ANA <br />Planning an Building Agency <br />Garden Grove Unified School District <br />Certification of Compliance ��R,',`re�,`,_N�% <br />f <br />Payment o 0 <br />School Facility Fees �'oved <br />FOR AT PERM i, FF SSUANCE <br />ellA169 Developer/Applicant'`-� AA _+ <br />M I�/� OIDE N C <br />�. � VDEn IBf <br />Address4000r, <br />A4 <br />Telephone Number <br />Project Location <br />Street Address Cl ty ZIP <br />OFFICE USE <br />Elem., School Int.School High School Thomas Map No. <br />Number of Square Feet Total $ <br />of Residential Space x <br />Number of Square Feet <br />of Commercial and <br />Industrial Space � X 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 />Dat4Developer/Applicant <br />-------------------------------------------------- <br />Receipt of Payment <br />This certifies that the above -named Developer/Applicant has paid school facility fees in <br />compliance with G��:)vernment Code Section 65995 and Education Code Section 17620. <br />These fee have bee received from <br />Dollars $ 3 b <br />Cash CheckCheck No. nk <br />D te SU erin n e t Designee <br />Garden Grove n' led School District <br />(71 6631m6442 <br />9703-69* (Rev. 6/14 <br />) <br />