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BUTTE COUNTY SCHOOLS IMPACT FEE CERTIFICATION FORM
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W.ne form per Building)
School District V ti t%��/ Vv ✓� �• Building Department No.
A.P. Number To '0/6 Jurisdiction: City County
Property Owner CS(4v6v/
Property Location/Address I007/ v
Subdivision Lot No.
Residential Development
No of Living Mobile Home Addition/ 'Supplemental to
Units Installation Conversion Permit #
'(No foundation inspection)'
'i...................................................................................................................
Cy,muxlercial/Industrial
Department
/-\ 1
/6y—o 27
Sq. Footage �f� /6:
tX1
(Group R)
Sq. Footage
i
ition (Including Exterior
� f� as)
Date jFloor Plans reviewed by chool District Personnel) ��4 �1 / �
District Ide `tibcation No. V 9LV V 1 O
II ! U iI tx 9-rAS_chool District certifies that � P
V (Applicant) U f LC�,
r�Ck-CJ
(Street Address)
(Phone Number)
0 �r
iLe.
i',�
gO[o(l
(City)
(State)
(Zip Code)
has complied with the requirements of Resolution No.
representing S� square feet.
School District Representative (/
Paid by Check # � Remarks:
by payment of $ 12. .
AB 2926 $
FULL MITIGATION $ �"�
a7 4 0'-:!
Date
Notice: You'may protest the imposition of the fees identified above by submitting a written protest to the District, in compliance-wit`h1 �Lf�
Government Code Section 66020(a), within 90 days from the date fees are paid. Failure to submit a timely written protest W.�Ip 01ohi4it
you from challenging the imposition of the fees in any court action.
If, subsequent to the School District Representative signing this Butte County Schools Impact Fee Certification Form, the School District is
notified by the applicable Local Planning Agency that this project is being reviewed under the California Environmental Quality Act (CEQA),
this project may be subject to additional school fees to fully mitigate its impact on the school district's schools.
White (applicant), Yellow (building department), Pink.(school district) feeformAs (10/98)dmm
.IFIEOU�ST FOR INSP
Location:
0
ION Permit No. -63- 16�1 4
Owner: Contractor:
Call (j Phone:
BLDG.
PLUIVIB/IVIECH
ELECTRIC
KHAJIVI.H��
PR�E-
S
INSPECTION
Form
Rough
Rough
Fnd/Ftg
,_ _J� .
Frame/Underfloor
Top Out
Temp. Service
Job Status
Stucco Lath
Gas Pipingrrest
Main Service
Corrections
Permit Renewal
Stucco Brown
Temp. Gas
Underground
Final
Ye�ies
Woodstove
Sewer Piping
Well Circuit
Brace Panel
Water Piping
POOL
Insulation
ShowerPan
Nailing
Gunite
Demo
Bonding
Light Niche
Corrections
Corrections
Corrections
Ready for
Final
Final
Final
Corrections
Final
Inspec.on:
Date: Comment: