DA Form 1

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                          22/01/2021
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 and garage
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 1.2— 7 February 2020