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— REFERRAL of SIGN PERM1T APPLICATION for KVDC REVIEW — <br /> To: KAILUA VILLAGE DES1GN COMMISSION, c/a PLANNING DEPARTMENT <br /> From: DEPARTMENT OF PUBLIC WORKS, BUILDING DIVISION <br /> SITE TAX MAP KEY NO.: (65 -]~&~D4-92) <br /> STREET ADDRESS: �~1000 44eA �' �|LU�KONA. HA�| <br /> ' ' � D(QK�`\' ��<� <br /> m*mcur *rr� /. '^'` '- ` ` '-\�~ ' <br /> S|G ^ ^� DATE: ����|i�� <br /> MAUNGA��PRE S: 1 -10O0 ��' ��� 90[} mnJ\g\ �nhQ/���k140 <br /> � , <br /> TELEPHONE NUMBER 32:1-L9410 <br /> APPLICANTS INTEREST, if not owner of business related to sign: <br /> _ <br /> BUSINESS RELATED TO REQUESTED SIGN: <br /> �� <br /> NA��EOF[X�NER(if same as Applicant,whte "Sarne''): "^"\ e) <br /> SIGNATURE: DATE: <br /> MAILING ADDRESS: <br /> * NATURE/TYPE OF BUSINESS: TELEPHONE NUMBER: <br /> OWNER OF MASTER LE a SEHOLD INTEREST(Master Lessee), if land ownership is not fee simple: <br /> NAME OF MASTE- 'E SEE() PIC- Re/alf/ ON- Lit/ <br /> SIGNATURE: � II OATE: Ws' <br /> ~»� . � ~ � <br /> �n� 1 | ' <br /> Print name cfw'sm�r�m� o�honeh�d Master Lessee: yv'� �' C) . <br /> �WA/L|N8ADD"!^ S: CP (V�N(C FaN9Dt0A�-9&c�i�4' /Jl�{)i _ ~. �40��4�'F�00r�Ok{).^iQ/8k <br /> TELEPHONE NUMBER: (0(CO 9DQ-��2� � q21 - /(09d <br /> RECORDED LAND OVVNE�' �0��0J� MA`����}0 ' t,W� ' ( 'O.1lM• <br /> (Fee Land Title Holder) / * OM, <br /> OVVNEFT8SIGNATURE: ' � ,. ' <br /> Print namoeofsignahur�not sanneaaUU* ho|dec ■) L�WYe,nce, p-opl/va <br /> MAILING ADDRESS: Qn��� [2&h1 V01k^n _VnN0^ A( O(0/14,C <br /> TELEPHONE NUMBER: y0010Q4,0-3( qb <br /> Please include the original plus ten copies(eleven(11) sets total)of the following documents for KVDC review: <br /> (1)this Referral form with all signatures: <br /> (2)the attached Checklist completed and signed by both the Applicant and Business Owner;and <br /> (3)the sign permit application form with its required submittals. <br /> FOR OFFICIAL USE ONLY: <br /> DPW Comments: Proposed sign meets basic Sign Code requirements for placement in Kallua Village <br /> (type and number of signs,ietter/logo height,sign area,placement elevation) <br /> Confirmed by: Date: � <br /> '4' Planning Dept.: County Zoning District: <br /> CAUsersWounnTemkto* w"p�w*plcaton!We" 4e2012.d= Match 2912 <br />