2935 W SKYWOOD CIR, BAnaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520 RECEIVED
(714)999-5454
MAY 1 B 2022
CITY OF ANAHEIM
PUNNING &BUILDING DEPARTMENTCERTIFICATEofCOMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
NOTICE:The 90-day period in which you may protest the fee described herein will begin on the date this fee is paid.However,if the fee was
imposed by the City or County as a condition of approval for your project,and you have received the requisite notice,the 90-day protest period
began at the time your project was approved.Returned checks (NSF)are subject to a $30.00 administrative fee.
RECEIPT NO.:ELEMENTARY DISTRICT:IGH SCHOOL DISTRICT:
rTaheim Union High School District1
OWNER INFORMATION:
Name:
Address:■
Phone Number:Home()CelK*^^
2
APPLICANT INFORMATION:
3 Name:
Cell (5p2.)-P/DCpyPhoneNumber:Home{
PROPERTY INFORMATION:
Project Address:LP ^/^iQcO‘9 Cj/LC/G-jg>Development Type:{/^ResidentiaLr^SV^t )Residential -Room Addition ()Commercial:^
()Single Family
Project Name:^
4
()Multi-Family Condos/Apartments ff of units:
/●>y .5
H.S.12.
COMMERCIAL:
Total Square Footage:
Multiplied by Current Rate
NTIAL:
Total Square Footage:
Multiplied by Current Rate
5 Elem.$Elem.$
Equals Total Fee:$Equals TotaLFeSTS
FEE WAIVER:
Fees Waived:(}Yes6 If yes,reason:No
ACKNOWLEDGEMENT^
The above respresentations as to square footage are true,Developer/Applicant agrees that if it is later determined that such respresentations
are not true.Certificate shall automatically terminate an^le appt^'iale City/County shall be notified.
Developer/Applicant Signature:
7
zvz
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
8 c
Rep.
US
Date :ive -Anaheim Union High School Districtresen
ACTUAL FEES PAID:^..
Anaheim Union H.S.Dist.
2,a●$Check No.
Check No.
9
$
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department