BA230788 - 178 Cooroy Mountain Road Cooroy QLD 4563 - PR230750 - DA Form 1 JDBA - Maroochydore Office

PART 9 – FOR COMPLETION OF THE ASSESSMENT MANAGER – FOR OFFICE
USE ONLY

 Date received:                                   Reference number(s):

 Notification of engagement of alternative assessment manager
 Prescribed assessment manager                                     Cathy Jensen
 Name of chosen assessment manager                                 Cathy Jensen
 Date chosen assessment manager engaged                            19/03/2024
 Contact number of chosen assessment manager
 Relevant licence number(s) of chosen assessment                   A1269610
 manager

 QLeave notification and payment
 Note: For completion by assessment manager if applicable
 Description of the work                                    New Dwelling Class 1a
 QLeave project number
 Amount                                                     Date paid
 paid ($)                                                   (dd/mm/yy)
 Date receipted form sighted by assessment
 manager
 Name of officer who sighted the form                       Cathy Jensen




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                                                                                    DA Form 1 – Development application details
                                                                                              Version 1.4— 15 December 2023