2208 S VERN ST, Bdt 02C(2£r^^'^^Anaheim Union High School District
501 Crescent Way,P.O.Box 3520,Anaheim,CA 92803-3520UNLIMITED RECEIVED(714)999-5454
MAY 1 6 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 period
began at the time your project was approved.Returned checks (NSF)are subject to a $30.00 administrative fee.
HIGH SCHOOL DISTRICT:
Anaheim Union High School District
ELEMENTARY DISTRICT:RECEIPT NO.:
1 IU
OWNER INFORMATION:
a.1
/Uw.,/.V..)
Cell (7/y)
Name:
Address:2 ‘^2^02-
Phone Number:Home (
APPLICANT INFORMATION:
Name;3
Cell (7/V)Phone Number:Home{
PROPERTY INFORMATION:
Project Address:.2ZO^S.
Development Type:(}Residential -New {)Residential -Room Addition
()Single Family
Project Name:202^-^^^ST:
4 ()Commercial:
()Multi-Family Condos/Apartments #of units:
ESIDENTIAL:COMMERCIAL:
Total Square Footage:
Multiplied by Current Rate
Etemj..^-:::
$
//99TotalSquareFootage:
Multiplied by Current Rate
5 =S Elem.
H.S.=$
Equals Total Fee:$=sEqualsTojaFfee:$=$
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 terminata^and the aDRFo<priate City/County shall be notified.
Developer/Applicant Signature:
7
CERTIFICATION:
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
65995.tD.j8
entatfve -Anaheim Union High School DistrictReiDate
ACTUAL FEES PAI $^^6'^.9l Check No.
Check No.
9 J73AnaheimUnionH.S.Dist.a
Distribution:Developer/Applicant,AUHSD Accounting Department,Elementary School District Accounting Department