000A88A4.002.tif · 132003.221037

    
 

 

Form 1 Ie iain eC ene

  
   
   

er aes a
‘ASSESSMENT SYSTEM:

ce

 

Common details
for ail applications

The completion of all questions on

Part A is mandatory for all applications.
For further information refer to the
guide for completing the application
form available from the assessment
manager or on the JPA website at
www. ipa.qid.gov.au

  

 

   

4. Description of land

The description must identify all land
subject of the application including
land/easements over which access is fo
be cbtained.

The jot & plan details (eg. SP / RP} are
shown on title documents or 4 rates
notice.

lf the pian is not registered by title,
provide previous lot and plan details.

 

Street address (include no., street, suburb / locality & postcode)

Maximilian 20, Noetr: SHORE, NooSA
‘ Postcode 4. 565

 

 

 

Lot & plan details (Attach list if necessary)

Let Fon @¢0 Si 237

 

 

 

 

 

Total area of land ¢m2/ha)

| “FAUT ha |

Shop / tenancy no. (If applicable) Storey / level (if applicable)

nA NA

In which local government area is the land situated?

NOOSA SuieE

 

 

 

 

 

 

2. Proposal
Provide details of the proposal feg. new
house / apartment building etc, demolition
‘removal of a house, extension fo
existing shop, new carport etc).

 

Details of the existing use of the land (Atfach proposal report if necessary)

[G@az Wie, VisexoR Recreations, Camer ToRgem,
Details of the proposal (Aitach proposal report if necessary) SfSeawron)

Nossa Noett: Sucee Ee-Tosoeem Gera. (see REme?)

 

 

 

3. Other parts of the form
compieted

Complete all other parts of the form
applicable to your application.

What other parts of the form are attached (Eg. Part B: ifthe application involves assessment against the Building Act,
Part D —- if the application involves assessment against the planning scheme for material change of use, Part F —if the application
involves reconfiguring a fot)

Caer DO, Paar &

 

 

4. Applicant details

Clearly identify who is making the
application. The applicant need not be
the owner of the land.

In signing and lodging this application,
‘the applicant is responsible for ensuring
the information provided is true. The
assessment manager, any referral
agency and the Chief Executive (where
applicable) will rely on this information
when assessing the application.

Ifthe applicant is a company, a contact
person must be shown.

All correspondence wil be mailed to this
address.

 

 

 

 

 

 

 

 

Name
fevene Lamo Heowe)es Pry Lxo |
Signature : oS Date

Me (tte; fd Chas IN 4 OB
Coniact person’ a Phgne no.

 

[Sanoy Nicae CERM Aostremun) 6S es eEq9 |

Mobile no. Faxno, Email address

ows7a7y | Bes1ees | Bandy [email protected]|

Postal address
fa Box 1400
SPeISG KUL Quo

 

 

 

 

Postcode a0 ly

 

5. Consent of land owners

Completion of this question is only
required if the applicant is not the owner
or the person authorised fo sign as the
owner.

Completion of this section provides the
owner’s consent to the lodgement of this
application. If there are multiple owners,

Name (In full) (Attach list if necessary)
Sse ftvacheo User
Signature/s (Or if a company, the ACN plus signatur... company seal & signatures) Date

—

 

See fewtikcnge lst

 

 

 

the consent of gach owner Is required. If

 

 

the owner is a company refer fo Guide 1. ‘
i

Contact et 8 (Optional)

   
 

 

 

 

 
 
 

 

RECEVING

OB , OFFICER'S NAMEIS

    

 

 

 

  

Accredzation Number__