07/1172 - MCU - New Dwelling [As Published] · 132007.1172

 

STEP Nie ae eta eee em aig re ee

 

 

 

SITE ADDRESS:

RP NO:

TO WHOM IT MAY

 

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bees

WLMERS COPY
BA /DA AUTHORITIES - SF22” 7"

Lot 206 Flooded Gum Place Black Mountain
SP157049

CONCERN

 

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.

_ dt 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

Address 36 Laver Drive, Robina, QLD, 4230
Client/s Name David Jenkins and Gillian Jenkins
Address Po Box 222 Childers QLD 4660
Registered

Owner/s Name Dip EQoAlp DEAS at Ce Lian Danis io Sees aKC

Address

Cc. YY

&

SIGN HERE

thedacs Dowd Coopalen C2Q—D WLCO,

Signature of Applicant / Builder

letters

 

 

 

.

 
 

 

Clidnt Signature lp Elient\ . Date

QiS 1077

“i x ea —— 12,5) o 7

Signature $f Registered Owner Signaturdbf Regislered Owner Date