DA Form 1 - Development Application Details

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: For completion by assessment manager if applicable
 Description of the work                                       Dwelling Alterations & Additions
 QLeave project number                                         S334927
 Amount paid ($)                 $ 0.00                        Date paid (dd/mm/yy)                      28/03/23
 Date receipted form sighted by assessment manager             1/03/2023 12:00:00 AM
 Name of officer who sighted the form                          Grant Johnsen




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