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County of 11awai`i <br /> J <br /> 201H Application Package <br /> Application Checklist <br /> (To be completed and signed by applicant and returned with application.) <br /> Project lame: Hanua'ula Living Community <br /> Done/Enclosed <br /> Correct number of copies(l original,3 copies. 1 electronic version) 19 <br /> COMV]ete APJ2IJC6JjQn <br /> 1. Application Checklist(completed and signed) <br /> 2. Summary Sheet Q <br /> 3. General information Section <br /> 4. Questions <br /> 5. Certifications and Assurances <br /> b. Index of Application Exhibits Included Q <br /> 7. Environmental Questionnaire(completed and signed) <br /> S. Exhibit Worksheets <br /> a. Project Cost Breakdown Worksheet(Exhibit A) <br /> b. Estimated Project Revenue(Exhibit B) ❑ 1 'or <br /> c. Operating Income(Exhibit C) <br /> d. Operating Expenses (Exhibit D) <br /> e. Operating Proforma (Exhibit E) <br /> 9. All Exhibits attached <br /> OiHCD'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 /> programs criteria,shall be returned to the applicant without further action. <br /> Applicant: Hanu. 'u la LLC <br /> Applicant Representative: �' a fry F`1t! <br /> gnature,Date) <br /> Section I-General Information <br /> s <br /> Form 201H-00f Page 2 2257pasr.doc v0111 1/2016 <br />