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PLANNING DEPARTMENT County of Hawaii 74-5044 Ane Keohokalole Hwy — REFERRAL of SIGN PERMIT APPLICATION for KVDCVRI&l\EANI 9e74o RECEIVED APR 0 9 2020 To: KAILUA VILLAGE DESIGN COMMISSION, c/o PLANNING DEPARTMENT From: DEPARTMENT OF PUBLIC WORKS, BUILDING DIVISION SITE TAX MAP KEY NO.: 740150010000 STREET ADDRESS: 74-5588 lani Road KAILUA-KONA, HAWAII NAME OF APPLICANT: PaALAI SIGNATURE: DATE: Z I MAILING ADDRESS: 11 is op S Ste 2500 Honolulu, HI 96813 TELEPHONE NUMBER: 808-763-2058 APPLICANT'S INTEREST, if not owner of business related to sign: BUSINESS RELATED TO REQUESTED SIGN: NAME OF OWNER (if same as Applicant, write "Same"): same SIGNATURE: DATE: MAILING ADDRESS: * NATURE/TYPE OF BUSINESS: convenience store TELEPHONE NUMBER. 808-763-2058 OWNER OF MASTER LEASEHOLD INTEREST (Master Lessee), if land ownership is not fee simple: NAME OF MAST R LESSEE: ValueRock Kona Coast SIGNATURE;//` DATE: Print name of signator if not same as titled Master Lessee.- Mart AQwhl MAILING ADDRESS: 6*700 �41(Rll i 1AoQ TELEPHONE NUMBER: COe-314-D'7(o� v RECORDED LAND OWNER: 1,jilitinknlini Trig Estate (Fee Land Title Holder) UI(An OWNER'S SIGNATURE: 6 x) DATE: Print name of signator if not same as title holder: Le-t- y„, MAILING ADDRESS: TELEPHONE NUMBER: Please include the original plus ten copies (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 pla ement in Kailua Village _ (type and umbe s etterHugo height, sign area, pl me elevation) SCANNED�1 Al i Confirmed by. Date: Z� 7 1�1� * Planning Dept.: County Zoni g District: APR 16 20211 C:\Users\ryoung\Desktop\Sign Permit Application Referral 4-2-2012.doc ��'��^--_4�