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1400 E. Sycamore St. :5f':A.,>f(o/:/:; (o/Vrr!wc 7/(~ AI RECEIVED FROM: ""1'9~-o"gLd9"T&STh1J,AVp.~ Deposit Breakdown: 6A-f17 A ANA . (A, 7 ~ ,0;S CHECK (s): RE: New Adll1l(l;SirAtlM ,B.;; iJl~e~\~~~~i~'ltJrM!P((y C~:::CY: AM:UNT: <I .,,~. ... .. CITY OF ANAHEIM FINANCE DEPARTMENT COLLECTIONS OFFICIAL RECEIPT/DEPOSIT \ \ \ Is\05 ~~, (%1~~~t~. :~4~~f?'\.- . J .. ~Lkt Chl(t{5 OLmedu COR Prepared'~y: ~"I~i~J~~t.~1~un JILt5 PIC FUND DEPT 3 3 SBSA REV SRC APPR UNIT FUNC 4 4 9 10 DO BSA 4 \ , ,"-'", N~ 172517 SO'sx_= 20'sx_= 10'sx_ = S'sx_= 1'5 X _ == Coin Total: Currency Total: ',Q,Q$T;4Qi'rr4PN4Y'; OBJ 4 - $ AMOUNT TOTAL: $ 1?J77. - Distribution: White - Acctg Yellow - Customer Pink - Reconcile Copy Goldenrod - Originating Dept. ....Please Do Not Write Below This Line.... Area Used for Cashier Validation t" D~te; 11/1fi!~5 S4 Receipt nOi 354~78 111 M1SClLLrI~IHmS 1 $1i3~,@8 27B412F7E4 Win @jj92 MI rn5tH!J\NEOUS $ZH.0~ 279412n2t; :1017 RECEIVED NO'i 211.005 h~tal h~llrt~'f"eti H3TLGH Total ~aYfu~~t ~1377.@O BUilDING DIVISION )'ran!; dat2~tU13/@5 ri~IP.~ ib89~~t~J COl-18 Rev. 6/05 NUV-1~-~~~~ 14'41 .... ~ ...v... '-1t:;,\.l;llt vy~y, r.v. l;lUJO.. ~~6.IJ, """QII'I;lIl1. V"I ,~QtJ,;I"'~"'.t;.V ~ ~~i:l ~~~:~~:~ FAX f1fctJtJc;s;::y", :",0', '~..,.:..M/? , ':,:',)>: ::{~~:!'~,: (...4.(: W'4'-'VI<--f.:::- >, ~ 1>/. '.,'" ,,"; ';,~ '(" , \~,~ 'I,'. J :~ I, " ,I ,..: ~:;. l ( PAv~:~F~C:~~~~~~~~I~C~ .., ~Jt~2i NOTXCE, The gO-day period in which you may p~~te~t the fee descrlbec;! herein will ;;e~il{p,~ ti1~ date thi~ f.i!~:~i~,:r ,Ji:,: ,:.:: paid. However, if the fee was imposed by the CitY or Cou~ty as a condition of appro~t'/Xl'~ your project; anll ~q~;:" .1- :, ':'" have received the requisite notice, the 90-day protest penod began at the time your, p"ro~ct was approved. ',;",' ;-, EI"m8nt~ry Di$trict:,..... ' tllgh Schoo>! Dls\:rl~l: . ">>,:: :;f,::':': /7/; . "'" '. r~ Anaheim Union .iii,': ,ig''': SchQt)l District' .. ' ".,. ',.' , 'I',,, !L~ .l....J , , ,,, , ' "I:'~ 'J' ."1 , '" W".:,,': ~I -I LA' ~~r.',;~'~ )~",'\' ,~ -,,' '" '~:: /' ",,;;,~,>~i"':':: - 67 4.,.., :ry .,;I';..""P'J;..I!. " . i<r /\ . r' .'.' :~)!,:I" ;{ '~:'.:' ... .___ ....:- ._ ___ _ _C_ ,', "." 'r\~".' ~!h' ,,/: ,I ,: :::~~:}'; i:~::>:~/,; ~ .~, ~ ,I I ~: : '"~I. ','Y . . :,- ""I I'" v i.i~"\~' ~~: ' , , ~,' ". I I' 'II!" j, . ",::,:/:i~:7:::')' '''I' :;'l'''.'''ll' ~I',', ""~~I~~""< , j:'1 :,:. ~',: ~:t'::"I: ~:,:', , ;,;,., \ Iii :~,~il "~', ~" ';.I~ <~~ ~:,f:;,: . , " ",,' '''~I ;':.\:, :', : ,,:," r/ I, ,? ~'\, t' .J ,~;\~:,'~'/;:,:,( :,:r ~)~,: i .' :... 11.1~ ~'I,:~!.';,.\ , ~ I,., , .10,1'1)1 ,'" 'I" . :::~,:':,'~;t ;<il:~\~::':: [ ], Level 3- AQi"~,~~ ,J:r :' I~~l ; )'" & ,',:. "J " , J'~: " ~~ . , , ,', I '.",j"." }' i, , " "~I:':I.~I" : L'1S/,' ":~\;~' '~~':""l' '~.~"~" ,~ ., ", >',..r,' i ~V;' >I,',.,' '. , 'r ' l"', >~ ,;J :' 'i,\~ I' \ , , :.J::l, "~' .,i.: ': ...;;~, ':';,,~ "'l,"'!"'.,:, ,'1\>'." " I"'~ ", (;,..", 'I~'~ :'t,,;,\~.':~~-: ~""',, ,I, ~J ''':, 'I'~; :,',:'lI:..:r ",',;,X'" ';: " ,~" 't:' I,' >', ',10 ',',1" ' , \ i~~'.r.:i..." ~,1' ~ , ':" 1 "" . ,~\j'lf, I' ':'" , ,Acknowledgement: " I'.; ", ~'~ J;:....: . ,~,I.',' " , . ,,1. ,~, ' , , The above represef'ltations as to square footage are trl)e. PeveJoper/ApplicClot agrees that If It Is.f~ter.~~~rmjned that'sudi :.: ,.~'::,~ ',~'~,~~':::,~.'~<:~ representations are not true, Certificate shall au omaticall". ,terminate a tile appropriate City/Count)< shall ,be notified. ;' ,:, , ":-'-';:": Developer/Applicant Signature: .: :. :,', ',,':,::::!,:':':\'::;.:,::',:):?; ~, " , , .':",':...1\ .,';.)", :.' ,:i; Developer/Applicant has paid schoor facility fees in complia~ ,WI~' Government Code :' :, ~ .'cr if'.,l " ;<::>:::,;'i~::';'i> ::'.',: '::: ,: ,~.' I:' .:,:;' :~ ., """ '~': .'." ':',' ',", " .' ", 'r'I' 'j , '/~ I" 1 ,,', :;:: ':'.":,:< ~~"',;t ;:~ <:-'.,:, :,:: i,:: , :::' ':;;>: ;:;::'~.'~~; ~:~:,:},' o Ow""r Jnform~t1on: Q,'1-.pt..,~c/ . Name: Address: Phone Number: ',Ii I, Applic:ant Information: Name: Phone Number: ~,:", ~ ' .. ~.'~ ,~~ ' , " , " , .....-)& ~":P-II"'/ dJyf , Property lllform;:,tion: Address of Project: Development Type: Project Name: Type: C;bmmerciaJ Yt?ci e', [ ;. "'"''''l~''2.e.' tial - ,,"oom 'Ad~itlon i"l [ ] ResidenMI - New [ l , . 1 Multi-FamilY Condos/Apartments.: #"of'lJnltS: ) Single Family " ~ < Commercial: ", " 6:?3(" $ -Lfl. ~~U.546 $ ./ r ~ $//dJIO . d{ -~(, ih5 Total Square Footage: MUltiplied by Current Rate: Elem. Resldent',,1l [ 1 Levell ( ] LeveI2'-ACsOQh>i Total square Footage: Multiplied by Current Rate: Elm:.$' H.Jl.,,~, . H.S. -$ =$ -~ Equals Total Fee: $ Equals Total Fee: $ Fee. Waiver:. ,', Fees Waived: ','-1 . NQ Yes If yes, reason: Certification, This certiftes tf1at tne above na Sections 53060 and 65995. / () It ~/~ ,;'" Date! I .) "~'.... . , r: rj _ ""-', . .~= If" - ,-, ,[.- , " " Representative - An airy:'! Unjon High School District Check No. Check. No. ?r..... ',," ",./;)0:(h) 5{li;l'C] ",'" " , $_J.J.-Jj, sA.: $ l/;:; Yr, Anaheim Union H.S. District Olsttlbvtlon: e;ltYICOU~ - Develo~er' . A~<<IuntJ"9 - Eh...mo:n~ry Dlstrlct 1-l'{)Il-;S [') ",i': 1/:.", ., '., P.02/04 .". ()2 O,,:>o\.l</.- , i b I 1) s~c"....o6t€? \'-\0 , -. ~:,,~ /(001\ \wINO ~ ~ , ' ,'<) .... ~ <u /~ G 'S f cO,.'vV[ 0 'f't- ~ ~+. ~ ;.< x "f< '{ "\e(l.- , J\eJ l.t.r ~, Q! o ,{-- - '" I) / \'"'~'-__L ., Q'S '. 1 t;\ '<-' r F'LANNINGDEPARTME 1 J ~ APPROVED (': DATE-Ti;,;\J!~18~" uJ \ BY .._um' 0__ (In!ti-..l ,,' 'z:nh8~) I )'..-he Syc.o..,....th'""l ., ~ 100/1 110/L40V . J I LfIQ..''-:::=; ~)I(u....o,-t. 50\Jlt-c..E FLOOD ZONE-+- HISTORIC DISTRICT RE.ViEW: N A S"H:l starn.? thi.5 D le..e IfC\& one on above line SEE BUILDING PERMIT FOR ANY CONDITIONS O~ y ~ro~ ~0J1..j f'\<2-0 \,1:>\R.- (3) \Wv,"'\WJ'" w"ft '1<.\', AD ~Wv'\. Ct 1t6JJT f: (L Y ~ ~-\6 q)<:6~ O<::lI:~ 00 a~--- I ~ N ~ ~~ O~ E~ ((- ~ >- V) uJlt (j ~.f\ :::t"€r --