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— REFERRAL of SIGN PERMIT APPLICATION for KVDC REVIEW — <br />To: KAILUA VILLAGE DESIGN COMMISSION, c/o PLANNING DEPARTMENT <br />From: DEPARTMENT OF PUBLIC WORKS, BUILDING DIVISION <br />SITE TAX MAP KEY NO.: 3 7 S (51) q, 00 e <br />7S-S77(pAl; '; <br />STREET ADDRESS: <br />NAME OF APPLICANT: • C <br />SIGNATURE: <br />KAILUA-KONA, HAWAII <br />f <br />DATE: <br />kms►, 1)-f 9(4, 7(S <br />MAILING ADDRESS: C7 X C1()ci.iiti . <br />TELEPHONE NUMBER: ( c(O 7..i(9 "02 t9 <br />APPLICANT'S INTEREST, if not owner of business related to sign: <br />(f)(A teCS <br />BUSINESS RELATED TO REQUESTED SIGN: <br />NAME OF OWNER (if same as A••licant, write "Same"): <br />SIGNATURE: DATE: <br />MAILING ADDRESS: 1'? ,1) 2t) A , ¼J "tA ---1- , H1 90_1_0 <br />* NATURE/TYPE OF BUSINESS:€ \Tau r TELEPHONE NUMBER: SU • 7 X95 <br />OWNER OF MASTER LEASEHOLD INTEREST (Master Lessee), if land ownership is not fee simple: <br />NAME OF MASTER LESSEE: <br />SIGNATURE: DATE: <br />Print name of signator if not same as titled Master Lessee: <br />MAILING ADDRESS: <br />TELEPHONE NUMBER: <br />RECORDED LAND OWNER: )0C -t01/4 <br />(Fee Land Title Holder) <br />OWNER'S SIGNATURE: <br />Print name of signator if not same as title holder: <br />MAILING ADDRESS: (36-7 LL&,QCi <br />TELEPHONE NUMBER: <V) q-11 60 <br />Ct‘Ne N\-1/41)-5 <br />' DATE: 4\b\Ict <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 Kailua Village <br />(type and number of signs, letter/logo height, sign area, placement elevation) <br />Confirmed by: Date: <br />* Planning Dept.: County Zoning District: <br />