1227 S CLAUDINA ST (6)1
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Anaheim Union High School Districtl
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520
(714)999-5454�
CERTIFICATE of COMPLIANCE
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 $30.00 administrative fee.
RECEIPT NO.:
ELEMENNTARY DISTRICT:
HIGH SCHOOL DISTRICT:
,A L�
Anaheim Union High School District
OWNER INFORMATION:
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Name: �r6 y �n2aV i)cr cc-1 06 of <
Address: C C A�JrI j hC V_A'_ Y 7 4 ci 7$ D J �i—\��1(iy�n.
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Phone Number: Home ('74) � �Q'� Cell (�71y) LmI ^104
APPLICANT INFORMATION:
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Name: NVNCG fv.tM (rxw" zjj�2fIDYN
Phone Number: Home ('71 •) �'3— 5aK!� Cell (114)
PROPERTY INFORMATION:
Project Address: Iam s. CICi)Ainc` CA q:i-A0CJ
rAnJ,oirn
Development Type: ( )Residential -New ( )Residential - Room Additio�(\/') Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments # of units:
Project Name:
COMMERCIAL:
RESIDENTIAL:
/ _
Total Square Footage: GD" 7
Total Square Footage:
Multipiled by Current Rate 9 L'A
r C;Zz/e �
Multipiled by Current Rate
Elem. $,-
=$
H.S. $ eon
Elem. _$
H.S. $ =$
Equals Total Fee: $ _ $
Equ al Fee: $ = $
FEE WAIVER:
Fees Waived:( ) Yes ( 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 rminate and the appropriate City/County shall be notified.
1,
Developer/Applicant Signature: 0 f_CkA5,
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
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Date' Repr sp`Dative - Anaheim Union High School District
ACTUAL FEES P ID: n
�� LOO �1�::;p^a 0
S $ • Check No. �7`
Anaheim Union H.S. Dist. $zotl Check No. oe ✓02
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department