801 S KOURI LN BAnaheim Union High School District
501 Crescent Way, P.O. Box 3520, Anaheim, CA 92803-350
(714)999-5454
CERTIFICATE of COMPLIANCE
PAYMENT of SCHOOL FACILITY FEES ( 5CQ1tFzq
CES: (1) The 90day 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 Oty or
ty 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 (A
-ned check (NSF) is subject to a $30.00 administrative fee); (2) you have the right to request an audit of Developer Fees per Gov. Code § 66023; (3) You
the right to file a written request for mailed notice of the District's Board meeting to review the Developer Fees Annual Report; and (4) The Developer Fees Annual
rt and supporting documents are available at: httgs�//www.auhsd.us/Distriet/Department/14195-Fadlities.
IRECE I PT NO.: ELEMENTARY DISTRICT: ASCHOOL naheimUniion High School District I
Name:
Address:
�Vi Tlwr
fd - \
Yl_� 4, ` 1 k"10 W'15.ar
Phone Number:
Home (
-gsil!T IN
) Cell (IlL/) 72y -03 83
APPUCANT- -MR)IRM ATION:
J Name:
�2C
�dAr1�oY�
TPhone Number:
Home (
) Cell (3/0) 3g6'/0 i13
PROPERTY INFORMATION:
Project Addres s:
--�jr'� \
,(7-�..�� l.J�•r`t �ov�-_
Development Type:
(p) Residential -New
( ) Room Addition ( ) Commercial:
( ) Single Family
Multi -Family Condos/Apartments If of units:
Project Name:
-.2 -'
COMMERCIAL:
RESIDENTIAL: / p
Square Footage:
Total Square Footage:
Total
Multiplied by Current Rate
Multiplied by Current Rate n
3,ri56.3D
Elem.$
_$
Elem.$�$
_$
H.S.
Equals TotalF
_$
Equals Total Fee:$ _$
FEE WAIVER:
Fees Waived: ( ) Yes Yn No If yes, reason:
above respresentations as to square footage are true evelper/Applicant agrees that if it is later determined that such
aesentations are not true, Certificate shalilAutomat� terminate and th opropriate City/County shall be notified.
This certifies that the above named Devel r/Appli nt has paid school facility fees in compliane with Government Code Sections
53090 and 65995. ! \ r1
I _ tom., v .
Date Repr entati -Anaheim Union High School District
FEES PAID: , nO /7
-J, $ �, f��D .3O Check No. 1�7 pd 3.5/
Union H.S. Dist. $ � n c^^d • �d Check No. / � 3 S / 'YCO�