HomeMy WebLinkAboutM.P. Mountanos, Inc. 2018-02-23VA
COU No. 1718185
Connection Fee Deferral Agreement rMUNISAPPLICATION 15
Planning and Community Development Department
City of Ukiah
300 Seminary Avenue
w _
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 to defer payment of impact fees until certificate of occupancy
Project Name: M P Mountanos, INC
Project Site Address: 558 N. STATE ST. Ukiah, CA 95482
Project Description (Attach additional sheets if needed)
-VL 19t -ax
APPLICANT: Name and mailing address of
person requesting the fee deferral.
NAME: M.P. MOUNTANOS
COMPANY:
ADDRESS: 605 N. STATE ST.
CITY/STATE/ZIP: UKIAH, CA 95482
PHONE#: (707) 462-1840
E-MAIL ADDRESS: MP PACIFIC.NET
SIGNATURE: 4,4--T, " ,
OWNER: Person who will be responsible for
payment of deferred fee when due.
NAME: MARK MOUNTANOS
COMPANY: M. P. MOUNTANOS, INC
ADDRESS: 605 N. STATE
CITY / STATE / ZIP: _UKIAH- CA 95482
PHONE: (707) 462-1840
E-MAIL ADDRESS:: �M�P/ PACIFIC.NET
SIGNATURE:"vim'
Total amount of connection fees deferred:
Sewer: $13,747.86
Water: $1,677.92
TOTAL: $15,425.78
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.
1 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.
Person Responsible f r paym nt: �i
Signature: `T Date: a " t'
Copies to:
Project Permit File:
Finance Director:
Assistant City Manager:
City Clerk:
(Original)