20200466 - PBCQ Engagement Agreement Document Signed - Received 03-12-2020.pdf

Applicants Details Apply details to:[x] Owner [_] Builder
(The Applicant is the person responsible for coordinating this application and will be our first point of contact).

 

 

 

 

 

 

 

 

Applicant: [ANNNA HINCKFUSS & DOUGLAS ALBERT HINCKFUSS ]

Site Details: [8/2 PANDANUS STREET NOOSA HEADS 4567

Address: => | Waflowa 2A, 05-520 Konstancin Jeziorna, Poland ]

Phone: +48601302835 Mobile:

Email: [email protected] contact: Julie-Anne, Frank Macchia Studio- [email protected]
Owners Details

(The Building Act requires us to directly advise the land owner of our engagement without encumbrance, accordingly, where the landowner is not
the Applicant, please provide the following details)

 

 

 

 

 

Owner: [DOUGLAS ALBERT HINCKFUSS |
Address: —> | Waflowa 2A, 05-520 Konstancin Jeziorna, Poland. |
Phone: Mobile:
Email: [email protected] |

 

Builder Details & Estimated Value of Works:
(Estimated Value of works and details of the QBCC Lic. Builder or Owner Builder conducting the works will be required prior to the issue of the BA.

 

 

 

 

 

Builder |
Address: | |
Phone: Hediste ead Sil Mobile: [| i
Email: | |

 

RegnNo: [Value of Works [

 

 

\/ we, being the Applicant listed above, accept this Fee Proposal or Invoice in the amount of the agreed fee below
as quoted and engage Pacific BCQ to provide Private Certification Functions pursuant to s47 of the Building Act
1975 and/or Regulatory Development Coordination and/or Consultancy Services, as described above, subject to
the Terms of Engagement, Notes and Specific Conditions attached to or shown herein. I/we declare that all
information in this application is true and correct and acknowledge that it is unlawful to provide false or misleading
information.

Applicant Signature * 2a AgreedFee $ 3807.03

| consent to the electronic submission of this Declaration. (Please return via email to [email protected])