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�B.UTTE COUNTY SCHOOLS•`DEVELOPMENT'FEE CERTIFICATION FORM
-., ( One Form per Building)
A.P. Number
�Q.9 cl-0 Building Department No.
School District D 90 E7L City r County Jurisdiction
Property Owner am i L A. J-- LOS �.
Project Location/Address L( C 14A10J9 RDPAL
Subdivision 6-S 7- Lot Number
l
Residential Development: /
Sq. Footagelg
//
# of Living MHI Addition (Group R)
Units
Commercial/Industrial: Sq. Footage
New Addition (Including Exterior
Roofed Areas)
Building Department Representative Date.
(,Floor Plans reviewed by School. District Personnel)
District Id No.��
{ uil /3-i,tiy i�prt� i� School District certifies that
(Applicant Name) .(Phone -Number)
y
(Street Address)
(City) (State) (Zip Code)
has complied with .the requirements of Resolution No.
o0
by the payment of $ 796 representing square feet.
y/3() h U
School Dist%% t Representative Date
PAID BY CHECK NO.REMARKS:
BANK NO
PAID W CASH
white -applicant, yellow -building department, pink -school district
SCHOOL.FEE (8/88)