Skmbt_C280-12111513221

*Please enclose documentation with request. Three (3) copies of plans and any other material relied on in support of the submission,

Applicationno. | Amount paid |

| Date paid | Receipt no. Initia! Date stamp

 

Receiving Officer oa 2 iz 4 = = =e

Assessment Responsibility (please tick v)

1 Planning Assessment (exceeds height limitinumber storeys and/or existing approvals
apply)

OQ Butiding Services (all other matters) ey =) ; |

Comments |

Payment options

{In person | Customer service centres: 8. 30 am to 4.3¢ 30 ) pm Monday to ) Friday (excludes Public holidays).

By mail | Cheque or money order to be! made payable t to: ; Sunshine Coast Regional Council. __|
i | Cheque jo Money order _ _. _{o Mastercard 'O Visa
| | Card number ~ — _. [Expiry date — iAmount $
|Name on card oo _ __ . __ Signature « of cardholder _ a - - |
{Phone - - _ _ — 7 - “lies receipt required? _ : “Oo Yes ONo |

3o0f3 2012/13 Regional Strategy and Planning Request for Referral Agency Response FM6106/2-22/06/2012