ECM_21572829_v1_DA Form 1 - 64 Reserve St (1)

Document Set ID: 21572829
Version: 1, Version Date: 29/07/2021


[OCR of page images]
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

 

Name of chosen assessment manager

 

Date chosen assessment manager engaged

 

Contact number of chosen assessment manager

 

Relevant licence number(s) of chosen assessment
manager

 

QLeave notification and payment

Note: Fo! eye telgm ey AeA ELSA tLe BELO Lele) (e2] 2), 2)

 

Description of the work
| QLeave project number
Amount paid ($) Date paid (dd/mm/yy) |
Date receipted form sighted by assessment manager |

Name of officer who sighted the form

 

 

 

 

 

 

 

Page 12
DA Form 1 — Development application details
Version 1.3— 28 September 2020

Document Set ID: 21572829
Version: 1, Version Date: 29/07/2021