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<br />East Hawai‘i Office · 101 Pauahi Street, Suite 3 · Hilo, Hawai‘i 96720 <br />Phone (808) 961-8288 · Fax (808) 961-8742 <br />West Hawai‘i Office · 74-5044 Ane Keohokalole Hwy · Kailua-Kona, Hawai‘i 96740 <br />Phone (808) 323-4770 · Fax (808) 327-3563 <br />County of Hawai‘i Planning Department <br />www.cohplanningdept.com · planning@co.hawaii.hi.us <br /> <br />APPLICATION FOR PLAN APPROVAL <br /> <br /> <br /> <br />This application must be accompanied by additional items as specified on the second page. <br />APPLICANT: <br />APPLICANT’S SIGNATURE: DATE: <br />PRINTED NAME OF SIGNER: TITLE: <br />MAILING ADDRESS: (if for a corp., LLC, trust, partnership) <br />CITY: STATE: ZIP CODE: <br />TELEPHONE NO.: EMAIL: <br />APPLICANT’S INTEREST: <br />(if not recorded land owner) <br />RECORDED LAND OWNER: <br />(Use counterpart forms for multiple owners) <br />LANDOWNER’S SIGNATURE: DATE: <br />PRINTED NAME OF SIGNER: TITLE: <br />MAILING ADDRESS: (if for a corp., LLC, trust, partnership) <br />CITY: STATE: ZIP CODE: <br />TELEPHONE NO.: EMAIL: <br />By signing above, LANDOWNER APPLICANT hereby authorizes the following to act on their behalf: <br />AUTHORIZED AGENT: <br />AGENT’S SIGNATURE: DATE: <br />MAILING ADDRESS: <br />CITY: STATE: ZIP CODE: <br />TELEPHONE NO.: EMAIL: <br /> <br />PROPOSED USE: <br />STREET ADDRESS OF PROPERTY: <br />TAX MAP KEY: (3) LAND AREA: ZONING: <br />STATE LAND USE DISTRICT: SPECIAL MANAGEMENT AREA: YES NO