HomeMy WebLinkAboutMountanos, Mark & Linda 2016-05-18Connection Fee Deferral Agreement
City of Ukiah
CtN- M.9 iSig 223
MUNIS APPLICATION # 11400
Planning and Community Development Department
300 Seminary Avenue
Ukiah, Ca. 95482
(707) 463-6207
APPLICANT- PLEASE PRINT CLEARLY AND FILL ALL APPLICABLE SECTIONS
Connection Fee Deferral Program
The Connection Fee Deferral�Program�allows todeferpayment of impact fees until certificate of occupancy.
Project Name: X33 1j `" Z (ZJ �` kl D�% S (tuvQ.r
Project Site Address: 33 Li 0 O2 , `' i M s-71-#20:1-
Project
T -Q1Project Description (Attach additional sheets if needed)
Pu pt -e
APPLICANT: Name and mailing address of person
requesting the fee deferral.
NAME VI flrei 4 1--,&",P‘ frI vi j /'Cr4CSS
COMPANY 1 "C )N3-rA JD5
ADDRESS: (00 6- N0 1Z4.1^ S44\4 --es
`' s -r. 2
CITY / STATE / ZIP V I 1 CA 5 / 8
PHONE#
E-MAIL ADDRESJ" ?, t
SIGNATURE: �_�`
cFt . PJ i -
OWNER: Person who will be responsible for payment of
deferred fee when due.
NAME:
COMPANY
ADDRESS:
CITY / STATE / ZIP
PHONE#
E-MAIL ADDRESS
SIGNATURE:
Total amount of connection fees deferred:
Sewer�4
I °l) QeD0
Water: 4SZ 1, G
2.1 2(7 Gf s
Payment information: There will be no building permit issued until all fees other than the deferred connection fees are
paid.
Projects receiving fee deferrals are not eligible for temporary occupancy.
I hereby submit this Connection Fee Deferral Agreement for review by the City of Ukiah. All information contained
herewith is true to the best of my knowledge.
Signature:
14,412_
Date: S — f
Copies to:
Project Permit File:
Finance Controller:
Senior Management Analyst:
City Clerk:
(Original)