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County of Hawaii <br /> 201H Application Package <br /> Application Checklist <br /> (To be completed and signed by applicant and returned with application.) <br /> Project Name: KUAKINI SENIOR LIVING <br /> Done/Enclosed <br /> Correct number of copies(1 original,3 copies. I electronic version) CJJ <br /> Complete Application <br /> 1. Application Checklist(completed and signed) <br /> 2. Summary Sheet Q <br /> 3. General Infonnation Section Q <br /> 4. Questions Q <br /> 5. Certifications and Assurances Q <br /> 6. Index of Application Exhibits Included Q <br /> 7. Environmental Questionnaire(completed and signed) Q <br /> 8. Exhibit Worksheets <br /> a. Project Cost Breakdown Worksheet(Exhibit A) D <br /> b. Estimated Project Revenue(Exhibit B) Q <br /> c. Operating Income(Exhibit C) <br /> d. Operating Expenses (Exhibit D) Q <br /> e. Operating Proforma (Exhibit E) Q <br /> 9. All Exhibits attached Q <br /> OHCD's receipt of this application,consisting of the documents above-referenced, <br /> does not constitute acceptance of this application. <br /> Applications must be complete in accordance with this checklist. <br /> Incomplete applications and applications that fail to meet individual <br /> program criteria,shall be returned to the applicant without further action. <br /> Applicant: KUAKINI HIGHWAY 75-6099 CORP. <br /> Applicant Representative: <br /> (Signature, Date) <br /> �N. <br /> Form 201H-001 Page 1 <br />