DA Form 1 - · MCU21/0097

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                                   Luke Owen-Jones
 Name of chosen assessment manager                               Luke Owen-Jones
 Date chosen assessment manager engaged                          09/04/2021
 Contact number of chosen assessment manager                     07 3063 9391
 Relevant licence number(s) of chosen assessment                 A1035338
 manager

 QLeave notification and payment
 Note: For completion by assessment manager if applicable
 Description of the work                                         Dwelling, pool and jetty
 QLeave project number
 Amount paid ($)                    $ $0.00                      Date paid (dd/mm/yy)
 Date receipted form sighted by assessment manager
 Name of officer who sighted the form                            Luke Owen-Jones




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