3169 W. COOLIDGE AVE. BAnaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA92803-352cRECEIVED
(714)999-5454
UNLIMITED
MAY 0 6 2022
CITY OF ANAHEIM
PLANNING &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
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.
was
RECEIPT NO.:ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District1 lOF~
OWNER INFORMATION;
LarI^'Name:
Address:2 5T74X
Ceil (7/y)
fPhoneNumber:Home (7/^fp (A
APPLICANT INFORMATION:
Name:
Phone Number:Home(iiu:)^C.j
A eg3
CeW(lif)4-ZL C'lrCf.
PROPERTY INFORMATION:
Lv^COOUOCtE AveProjectAddress:
Development Type:(y.)Residential -New,{)Residential -Room Addition
{ )Single Family
Project Name:CciOLfPC^P
4 ()Commercial:
()Multi-Family Condos/Apartments#of units:
COMMERCIAL:RESIDENTIAL:
Total Square Footage:
Multiplied by Current Rate
Elem^^
Total Square Footage:
Multiplied by Current Rate
5 = $Elem.S
I.S.$= $H.S.
Equals ToULPm:$= $Equals Total Fee:$= S _
FEE WAIVER:
Fees Waived:()Yes6 No If yes,reason:
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 terminat
Developer/Applicant Signature:
7 OTiatcUl.late City/County shall be notified.appro
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
8
V
ative -Anaheim UniSn High School DistrYct!)ate rese
ACTUAL FEES PAID:^/3/^,!$Check No.
Check No.
9
Anaheim Union H.S.Dist.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department