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RECEI'V'ED OC i 2 0 2020 <br />— 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— --�'S-�t' —��1.— j-cz <br />STREET ADDRESS: <br />NAME OF APPLI <br />SIGNATURE: <br />MAILING ADDRESS: <br />TELEPHONE NUMBI <br />U/�KAILUA-KONA, HAWAII <br />r• APh/-/i A /1 11 w Z -1I <br />APPLICANT'S INTEREST, if not owner of business related to sign: <br />BUSINESS RELATED TO REQUESTED SIGN: <br />NAME OF OWNER (if same as Applicant, write "Same"): <br />SIGNATURE: DATE: <br />MAILING ADDRESS: <br />* NATURE/TYPE OF BUSINESS: TELEPHONE NUMBER: <br />OWNER OF MASTER LEASEHOLD INTEREST tMaster Lessee), if land ownership is not fee simple: <br />NAME OF MASTER L i- CLP .0 .1,.N - <br />SIGNATURE: DATE: q/j11 CA, rl/AE <br />Print name of signator if <br />MAILING ADDRESS: <br />TELEPHONE NUMBER: <br />RECORDED LAND OWNER: "L <br />(Fee Land Title Holder) Sjs <br />OWNER'S SIGNATURE: /u <br />Print name of signator <br />MAILING ADDRESS: <br />TELEPHONE NUMBEI1. <br />it Y14, 7.47 <br />DATE: <br />Please include the original plus ten conies (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, Ietterflogo height, sign area, placement elevation) -.-- r-- -- <br />Confirmed by: Date: <br />* Planning Dept.: County Zoning District: .4 <br />a4 <br />C"w Y«U9 V Pomiit ApphovO„ Rd'ard 4-2-2012.doc By ���_ <br />/X - <br />