200394 - 161 Cooroy Belli Creek Road, COOROY - Applicant's Consent.jpg

 

 

EarthCert°

PO Box 432 POMONA QLD 4568 « Ph 07 3063 9391 * [email protected] * ABN: 49 162 782 014

Luke Owen-Jones
Building Certifier
Queensland Building Construction Commission Registration A1035338

Applicants Consent

If you would like to proceed please sign and return this section of the fee proposal along with the a
complete DA Form 2 (available online) as evidence of engagement of EarthCert as your private
certifier.

Applicants Name:

\<ea w\ Goer \ cz

Property Address:

Ib. Coovey Belli cK Road
Cooroy @Qveo ASlC2

snes XXL Cron UTA,

Dated \\ \\ 2\

Details of person responsible for payment:

Name Ka VA Goey \. v2.
address Wo Cooroy Bells CHeex Road
Email \Z\s\ CS COZ3QLAIMG \ , (Om