1225 W LASTER AVE, #BAnaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-3520 RECEIVED
(714) 999-5454
MAY 0 3 2023
CITY
CERTIFICATE Of COMPLIANCE PLANNING &BUUIILDINGD PI RTMENT
PAYMENT of SCHOOL FACILITY FEES L (I
NOTICE: The 90-day period in which you may protest the fee described herein will begin on the date this fee is paid. Howeverif
imposed by the City or County as a condition of approval for your project, and you have received the requisite notithe fee was
ce, the ver, if protest period
began at the time your project was approved. Returned checks (NSF) are subject to a $30.00 administrative fee.
RECEIPT NO.: ELEMENTARY DISTRICT: HIGH SCHOOL DISTRICT:
1
l pe = j\ Anaheim Union High School District �\
OWNER INFORMATION: �—
Name: � s /� ct,
Address: 2
Phone Number: Home Ti Cell ( )
APPLICANT INFORMATION:
l 3 Name:_ IVtGlI I ) rt
Phone Number: Home ( ) Cell
PROPERTY INFORMATION:
Project Address: IJ2-S VV 94ef 71 U�
4 Development Type: (/) Residential -New ( ) Residential - Room Addition ( ) Commercial:
( ) Single Family ( ) Multi -Family Condos/Apartments # of units:
Project Name: `�--a` � .�L�
COMMERCIAL: RESIDENTIAL:
Total Square Footage: Total Square Footage: �_
1Multipiled by current Rate Multiplied by Current Rate nn
5 Elem.$ Elem. $$
H.S. Fes$
Equals Total.F _ $ Equals Total Fee: $ _ $
E WAIVER:
6 Fees Waived: ( ) Yes K,pNo 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 automaticallyterminate nd the appropriate City/County shall be notified.
�]
Developer/Applicant Signature: 1- / I
This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and
6599 .
8
Date Represen e - heim Union High School strict
ACTUAL FEES PAID:
9 4 f—=— !� $ ( �p • Qa Check No. D /�
Anaheim Union H.S. Dist. $_4 2 Check No. _ t?-& 9
Distribution: Developer/Applicant, AUHSD Accounting Department, Elementary School District Accounting Department