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07/0785 - MCU - Preliminary Building work assessable against the planning scheme [As Published] · 172007.785
eed one
. OFFICE USE ONLY (appricabie to scsessment manegers)
INTEGRATED PLANNING ACT 1997 Part A, Version 2.4, 29 May 2006
O Andea HoTem,
Plan / Drawing / Report Number
Please fefer to attached list
Fe
PLEASE NOTE: The assessment manager may refuse to accept en application that, at the time of lodgement, fails to provide all applicable information required by Part A
and any other relevant part of Form 1.
a 2601. WE |
To. Counel, I have been engaged as he private certiier for the building work referred to in this application,
Dateofengagement { / Accreditation Number, _____ Name’ Signature:
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