Owners Consent Form Completed Signed - Received 30-06-2020 · 51995.1530.04

                                 OWNERS CONSENT
           Privacy Act 1988, Information Privacy Act 2009, the Planning Act 2009
                                  and the Building Act 1975
                                                                                                           PACIFIC BCQ_
                                                                                                           BUILDING CERTIFICATION QUEENSLAND

                                                                                Dear Sir/Madam:
Pursuant to the Privacy Act 1988, the Information Privacy Act 2009, the Planning Act 2017 and the Local Government Act
2009, IA^ being the Registered Owners of the property located at:

Address:
      ^              ^ <T______ S*                      c / ^ sy/                   s          ^ • y*4C>      ____________________
                                                                £5<££. sy f
Lot & Plan Number:______________________________________________________________________________
____________^07^                                    g      ______ C 7^^                    2 2.          J___________________
Local Government Area:__________________________________________________________________________
__________________________ Q J A                                                        _______________________________________________

Ownership Name/s (Individual Persons, Company and or Family Trust Details (Include ACN where applicable):
                o C? ^ /Z 7~-A.


Consent to Pacific BCQ:
   (1) Acting on my/cjfeif behalf in making all requisite Development Applications (Inc. Demolitions), Preliminary
        Applications, Concurrence Agency Applications, Plumbing Applications and/or Local Law Applications in relation
        to abovementioned property and premises ;
   (2) Obtaining all requisite property information and/or records inclusive of details and copies of Approvals, Decision
        Notices, Permits, Plans, Specifications, Requisitions and/or Enforcement Action details in relation to the
        abovementioned property and premises;
   (3) Entering the property at all reasonable times during business hours for the purposes of inspections; and
   (4) Representing our interests in matters of Appeal to the Building and Development Dispute Resolution Committees
        where required.
Yours faithfully

               Name+                                 Designation*                                 Signature                           Date
           (Please print)                     (Director, Secretary etc. -
                                                     if applicable)
           sZ t'      <1              A
                                                                                                                                So /<£v£?0
                                                        —
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t If there are multiple individual owners of the land the signature of each owner is required.
t A company owns the land consent without the use of a common seal by the signatures of (a) 2 directors of the company;
  or (b) a director and a company secretary of the company; or (c) for a proprietary company that has a sole director who is
  also the sole company secretary—that director.



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