1235 E SYCAMORE ST, BAnaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
(714)999-5454
UNLIMITED
received
JUL 1 4 2022
\
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES CITY OF ANAHEIM
PLANNING &BUILDING DEPARTMENT
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 periodbeganatthetimeyourprojectwasapproved.Returned checks (NSF)are subject to a $30.00 administrative fee.
RECEIPT NO.:ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District An
OWNER INFORMATION:
Name:
Address:/2_'-4
Phone Number:Homef-^/^1 *7 ^C
Av-„y cy rrr'>2
c
^y ny
APPLICANT INFORMATION:
Name:
Phone Number:Home(
K r A r/'o3
Cell (T?/^
PROPERTY INFORMATION:
N\>/AgC::rr-vProjectAddress:
4 Development Type:(^Residential -New^()Residential -Room Addition
(^Single Family
()Commercial:
()Multi-Family Condos/Apartments#of units:
✓SfW^pProjectName:
RKIDENTIAL:COMMERCIAL:
Total Square Footage:
Multiplied by Current Rate
Total Square Footage:V_o\.or*A
Multiplied by Current Rate
5 =$Elem.$
[S.$=$H.S.
Equals TotalfeefS =$Equals Total Fee;$=$_
FEE WAIVER:
^Fees Waived:()Yes
acknowledgementP^
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 and the appropriate City/County shall be notified.
Developer/Applicant Signature:
No If yes,reason:
KrB\<x!\r/n
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
8
3^●V
Repre^ej^tative -A?i^heim Union High School DistrictDate
ACTUAL FEES PAID:
s9£r^i>/^3/Check No.
Check No.Anaheim Union H.S.DIst.
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department