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409 S. Shields Dr. ~ Anaheim Union High School District 501 Crescent Way. P.O. BOl< 3520, Anaheim, CA 92B03-3520 ~. ,(714) 999-2168 I' (714) 520-5741 FAX CERTIFICATE of COMPLIANCE PAYMENT of SCHOOL FACILITY FEES NOTICE: The gO-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 gO-day protest period began at the time your project was approved. Elemenh1;ict: High School District: Anaheim Union High School District Re~p~;: g Owner Information: Name: Address: Phone Number: Applicant Information: Name: Phone Number: ( Property Information: Address of Project: Development Type: project Name: Type: Commercial: Total Square Footage: Multiplied by Current Rate: Elem. $ H.S. $ Equals Total Fee: $ Fee Waiver: Fees Waived: Yes ) ~~~~ ~ ''', ~~. [ [ )0 Residential - RoomAdditlon ] CommerCial ] Residential - New ] Single Family Multi-Family Condos/Apartments - # of units: ~$ ~$ -$ Residential: [ ] Level 1 [ ] Level 2 - ACSO Only Total Square Footage: Multiplied by Current Rate: Elem.. $ H.S. Equals Total Fee: $ No If yes. reason: Acknowledgement: The above representations as to square footage are true. Developer/Applicant agrees that If It is later determined that such representations are not true, Certificate shall autom I er{"lnate and the appropriate City/County shall be notified. Developer/Applicant Signature: Certification: This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 nd 65995. $ $ tr;o</ ~ ~oi./. fa Check No. Check No. 1(3 It.? DiotnbU;rJifuSD'V"OP" - A"ountlng - Element..y D;,'n" ~ Anaheim Union High School District 501 Crescent Way, P.O. Box 3520, Anaheim, CA 92B03-3520 (714) 999-2188 (714) 520-5741 FAX 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 yo~ have received the requisite notice, the 90-day protest period began at the time your project was approved. Re:;;&io~ Elementary District: I\lI \',0<... High School District: Anaheim Union High School District " Owner Information: Name: Address: Phone Number: (l'LO '0 (1!xb-; r to 0; ~. ~ SI-uRM slA) thalw,,", (~ - o,U)- 1//4 Applicant Information: Name: Phone Number: ( Sam.\? Property Information~ Address of Project: Development Type: Project Name: Type: 1Jo 1 G. '&h;eljs &. ()/l'\O-~j ~ReSidential - Room Addition [] Commercial ] Residential - New [ v{' Single Family ( Multi-Family Candas/Apartments - # of units: Equals Total Fee' .----- -~.-/'.. =$ =$ -$ Residential: It 'cL717>'lal OT~~r '-10 Cot ""'"d!.iPog [ ] Level 1 [ ] Level 2 - ACSD Only [ ] Level 3- ACSO Only Total Square Footage: ~ 10 '1l' ~+ Multiplied by Current Rate: Elem. $ /.{;;;;: = $c:l35 .';<0 H.S. $ /.I;;L. = $0<..:35'..,20 Equals Total Fee: $ 0<.,;J.. <.J = $ 4l}o .'fo. Commercial: Total Square Footage: Multiplied by Current Rate: Elem. Fee Waiver: F:ees Waived: Yes ] No lfyes, reason: ACknowledgement: The above representations as to square footage are true. Developer/Applicant agrees that if it is later determined that such representations are not true, Certificate shall automatically terminate and the appropriate City/County shall be notified. Developer/Applicant Signature: ~ Certification: This certifies that the above named Developer/Applicant has paid school facility fees in compliance with Government Code Sections 53080 and 65995. /o} 1-3/DS Date Actual Fees Paid: J1\~(\o\ic..... Anaheim Union H.S. District $ $ 0'( 35. c20 c23'S.d.-O Check No. ~ ~ ~ Check No. -( Dlstrltlutlon~ Citv/C'.ountv - Devf'looer - Accountlno . Elementarv District