2342 W FALMOUTH AVE, BgL020^2-001^^3
Anaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520
(714)999-5454
UNLIMITED RECEIVED
JUN 0 1 2022i»>n
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES
CITY OF ANAHEIM
PUNNING &SUILDING 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 period
began at the time your project was approved.Returned checks (NSF)are subject to a $30.00 administrative fee.
RECEIPT NO.:ELEMENTARY DISTRICT:HIGH SCHOOL DISTRICT:
Anaheim Union High School District1
OWNER INFORMATION;
MfoU~1g;l^Name:
Address:2 22j±±h-Md
Phone Number:Home(
APPLICANT INFORMATION:
3 Name:
Cell (%'d 417^-Phone Number:Home(
PROPERTY INFORMATION:
Project Address:CJ-o
4 Development Type:()ResidentigJ^evQ (’X Residential -Room Addition{)Single Family ()Multi-Family Condos/Apartments#of units:
()Commercial:
Project Name:
COMMERCIAL:
Total Square Footage:
Multiplied by Current Rate
Elem.^
RESIDENTIAL:
Total Square Footage:
Multiplied by Current Rate
Elem.S ^C
=$J
5 =$
●S.$=S H.S.
Equals Total.Fe^$=$Equals Total Fee:$
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 terminate and the appropriate City/County shall be notified.
Developer/Applicant Signature:::l\.
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.
8 .-g/iqUz,^^
Repfesentati^-Anaheim Union High School DistrictDate
ACTUAL FEES PAID:
..:2
s
$Check No.
Check No.
9
Anaheim Union H.S.Dist.
Distribution;Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department