Laserfiche WebLink
-- 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.: 0) 1 'S-009'• 00(4 <br /> STREET ADDRESS: 7G-S?Gg #t KAILUA-KONA, HAWAII <br /> NAME OF APPLICANT: lc %O <br /> SIGNATURE: DATE: <br /> MAILING ADDRESS: /SL7-Z K& �'r kuci jJ; ktv7S0 <br /> TELEPHONE NUMBER: <br /> APPLICANT'S INTEREST, if not owner of business related to sign: ✓��. ti'G- <br /> BUSINESS RELATED TO REQUESTED SIGN: <br /> NAME OF OWNER (if same as Applicant, write "Same"): �Row%o-% etJk4t« �_ 4k <br /> SIGNATURE: DATE: <br /> MAILING ADDRESS: l$ �,iree'4 ✓wlv 4�1 nG$i3 <br /> * NATURE/TYPE OF BUSINESS: TELEPHONE NUMBER: 20$ 05- 3,360 <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: <br /> (Fee Land Title Holder) <br /> OWNER'S SIGNATURE: DATE: <br /> Print name of signator if not same as title holder: -$a Koyte-Ato &tkc t <br /> MAILING ADDRESS: �S-SZCsq l l�i QdiN� C r 1w KA A °1.4�1t0 <br /> TELEPHONE NUMBER.- <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 /> KAKVDC'Application Forms\Srgn Permit Application Relerral.doc March 2012 <br />