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— REFERRAL of SIGN PERMIT APPLICATION for KVDC REVIEW — To: KAILUA VILLAGE DESIGN COMMISSION, do PLANNING DEPARTMENT From: DEPARTMENT OF PUBLIC WORKS, BUILDING DIVISION SITE TAX MAP KEY NO.: 7-5-007-009 STREET ADDRESS: 75-146 Sarona Rd. KAILUA-KONA, HAWAII NAME OF APPLICANT: Ina Custom Signs SIGNATURE: DATE: 4/9//4- MAILING ADDRESS: 730 Kilauea Ave.Ste. 1 Hilo, HI 96720 TELEPHONE NUMBER: (808)935-4491 APPLICANT'S INTEREST, if not owner of business related to sign: Sign Company BUSINESS RELATED TO REQUESTED SIGN: NAME OF OWNER(if same as Applicant, 'te"Same"): Kona Hospitality LLC SIGNATURE: t DATE: j/2.3-/-/q MAILING ADD- A,.• • At . .: A . . • NATURE/TYPE OF BUSINESS: HOTEL&RESORT TELEPHONE NUMBER:206-497-2489 OWNER OF MASTER LEASEHOLD INTEREST(Master Lessee), if land ownership is not fee simple: NAME OF MASTER LESSEE: SIGNATURE: DATE: Print name of signator if not same as titled Master Lessee: MAILING ADDRESS: TELEPHONE NUMBER: RE • -D D _• I •WN_.R: KONA HOS' ITALITY LLC (Fee Land Title Holder) OWNER'S SIGNATURE: ! ( DATE: 3)2 7/// Print name of sign- • • same as title hoIde Dot V I d MAILING ADDRESS: 2200 6th Ave#520 Seattle,WA 98721 TELEPHONE NUMBER: 206-497-2489 Please include the oriainal nlus ten dies(eleven(11)sets total)of the following documents for KVDC review: (1)this Referral form with all signatures: (2)the attached Checklist completed and signed by both the Applicant and Business Owner;and (3)the sign permit application form with its required submittals. FOR OFFICIAL USE ONLY: DPW Comments: Proposed sign meets basic Sign Code requirements for placement in Kailua Village (type and number of signs,IetterAogo height,sign area,placement elevation) Confirmed by: Date: • Plannina Dept.: County Zoning District: C\L envyounplDssk1OO'Sipn Pe,,mt ApplcaOon Rdertol 4-2-2012 Doc March 2012