HomeMy WebLinkAbout069-180-027• BUTTE '..COUNTY SCHOOLS DEVELOPMENT. -FEE CERTIFICATION FORM
` (One Form per Building)
A.P. Number �'o9 Building Department No.
School District City Q County Q Jurisdiction
Property Owner_°"Q�'V •p
Project Location/Address
Subdivision n� �,,� Lot Number qir
U
Residential Development:
a Sq. Footage lj�;IO2%,
# of Living MHI Addition (Group R)
Units
Commerc'al/Industrial: a Sq. Footage
New Addition (Including Exterior
Roofed Areas)
f
Building"Department Representative / Date
District Id No. 76
p� p School District certifies that
(Applicant Name) (Phone Number)
(Street Address)
(City) (State) (Zip Code)
has complied with the requirements of Resolution No. S-647-11`,
so
by the payment of $ representing square feet.
School DWrict Representative Date
PAID BY CHECK NO . REMARKS:*
BANK NO
PAID BY CASH
white -applicant, yellow -building department, pink -school district
SCHOOL . FEE (5/88)