DA Form 1 - Development Application

PART 9 – FOR COMPLETION OF THE ASSESSMENT MANAGER – FOR OFFICE
USE ONLY

 Date received:                                   Reference number(s):

 Notification of engagement of alternative assessment manager
 Prescribed assessment manager                                   Pacific BCQ
 Name of chosen assessment manager                               Don Grehan
 Date chosen assessment manager engaged                          30/10/2020
 Contact number of chosen assessment manager                     07 5412 1520
 Relevant licence number(s) of chosen assessment                 A739669
 manager

 QLeave notification and payment
 Note: For completion by assessment manager if applicable
 Description of the work                                         Convert an existing verandah to a habital room and
                                                                 increase GFA.
 QLeave project number
 Amount paid ($)                    N/A                          Date paid (dd/mm/yy)           N/A
 Date receipted form sighted by assessment manager               N/A
 Name of officer who sighted the form                            N/A




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                                                                                        DA Form 1 – Development application details
                                                                                                     Version 1.2— 7 February 2020