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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) 0 <br />Comnlete Appication <br />1. <br />Application Checklist (completed and signed) <br />2. <br />Summary Sheet <br />Q <br />3. <br />General Information Section <br />Q <br />4. <br />Questions <br />Q <br />5. <br />Certifications and Assurances <br />Q <br />6. <br />Index of Application Exhibits Included <br />Q <br />7. <br />Environmental Questionnaire (completed and signed) <br />Q <br />8. <br />Exhibit Worksheets <br />a. Project Cost Breakdown Worksheet (Exhibit A) <br />D <br />b. Estimated Project Revenue (Exhibit B) <br />Q <br />c. Operating Income(Exhibit C) <br />Rl <br />d. Operating Expenses (Exhibit D) <br />Q <br />e. Operating Proforma (Exhibit E) <br />Q <br />9. <br />All Exhibits attached <br />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: <br />Applicant Representative: <br />�Y <br />KUAKINI HIGHWAY 75-6099 CORP. <br />(Signature, Date) <br />Form 201H-001 Page 1 <br />