Development Application part 1 of 2 Application Forms MCU11/0198

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 3:0S                                                                ?UILDERS                                  Coral
                                                   BA 1 DA Authorities                                         Homes
                                                                                                               RUt; T ON 1 RUST
                                                                                                                 SIN"F INFO




        SITE ADDRESS:            Lot 5 Black Mountain Road, COOROY

        PLAN No.:                RP227335

        TO WHOM IT MAY CONCERN

        FAVId:Lsl;1iiA"

        The Registered Owner of the above site consents to the Owner and Applicant submitting a BA / DA for the
        property as noted above and to receive a permit to build on said property and have signed below.



        The Client and Registered Owner agree to the lodgement by Coral Homes of the BA / DA on our behalf to
        either a Private Certifier as nominated by Coral Homes or direct to Local Council.

        It is further agreed that should Coral Homes choose to lodge with a Private Certifier then such nominated
        Private Certifier is authorised to make amendments considered necessary.

        It is further agreed to give authority for an agent from the nominated Private Certifier to lodge and sign any
        council or state government forms necessary for submission for and on our behalf.

        It is further agreed for Coral Homes to receive all copies of the building approval. Coral Homes will then
        forward a copy to the Owner.


        Applicant's Name:        Coral Homes OLD Pty Ltd
        Address:                 36 Laver Drive, Robina, OLD, 4230



        Clients Name:            Philip Broad and Frances Broad, Aaron Lindsey and Aimee Lindsey
        Address:                 27 Leafhaven Drive, TEWANTIN QLD 4565


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        Owner/s Name:                                                                                          block
        Address:              27           f°/ML,--.,j D rv^.7'^wAN>-1-N.^Lv. X565                             letters


                x               v N 11
                Signature     Applicant Builde

                                                                                                   10 /09/)
                                                           .Sign     ire of i nt                   Date

                                                          x                                        ► o /oq /I I
               Signature of Client                            Signature of Client


                            of Registered Owner                gnkture oJf Gegistered Owner        Date



                Signature of Registered Owner                 Signature of Registered Owner        Date

                                                                                                                      Page 1 of t
                                                                                                                Updated: 14102/08
  Authorised: KWO                                                                             Copyright Coral Homes Pty Ltd: 1999