HomeMy WebLinkAboutBLG_Property_Owner_Declaration
V3 4/10/2023
DEPARTMENT OF PUBLIC WORKS
PROPERTY OWNER DECLARATION FORM
INSTRUCTIONS
COMPLETE THE SECTIONS BELOW. AN EMAIL ADDRESS IS REQUIRED FOR ALL CONTACTS – ALL
COMMUNICATION REGARDING YOUR APPLICATION WILL BE EMAILED.
LOCATION INFORMATION
(VERIFY AT: www.hawaiipropertytax.com/search.html)
PARCEL NUMBER ----LOCATION ADDRESS
PROPERTY OWNER INFORMATION (Owner contact information is required)
(VERIFY AT: www.hawaiipropertytax.com/search.html)
IF PROPERTY OWNER(S) NAMED BELOW DOES/DO NOT MATCH THE COUNTY’S REAL PROPERTY TAX
OFFICE RECORD, PLEASE SUBMIT A COPY OF THE CURRENT OWNER’S PROOF OF OWNERSHIP.
OWNER NAME
MAILING ADDRESS
PHONE NUMBER
EMAIL
OWNER NAME
MAILING ADDRESS
PHONE NUMBER
EMAIL
OWNER NAME
MAILING ADDRESS
PHONE NUMBER
EMAIL
AUTHORIZED AGENT INFORMATION
AGENT NAME
MAILING ADDRESS
PHONE NUMBER
EMAIL
Hawaiʻi County is an equal opportunity provider and employer
DEPARTMENT OF PUBLIC WORKS
ADDITIONAL CONTACT INFORMATION (LIMIT 2)
NAME
MAILING ADDRESS
PHONE NUMBER
EMAIL
NAME
MAILING ADDRESS
PHONE NUMBER
EMAIL
Pursuant to Hawaii County Code, Section 5-4-1(a)(7), and by my signature below, I certify the following: (1) I am
the owner of the property described above or the owner’s authorized agent and I consent to the submittal of
this permit application; (2) the information in this application is accurate and complete; and (3) I understand that
all contacts listed above will receive communication regarding the permit application and plans.
PRINT NAME
CHECK THE BOX IF
PROPERTY OWNER
INFORMATION ABOVE
MATCHES RPT’S DATA.
If no, proof of ownership is
required. Verify at:
www.hawaiipropertytax.com/
search.html
SIGNATURE DATE
Hawaiʻi County is an equal opportunity provider and employer