Form 1 - Application
Form 1 - Application
Form 1 - Application
FORM 1
Regulation 301
From
Owner/ Agent of Owner (please circle one):
Postal Address:
Address for
giving or serving
of documents:
Postcode:
Telephone:
Indicate if applicant is a lessee or Licensee of Crown land to which this application applies (tick if yes):
Contact person:
Telephone:
Email:
Postcode:
Telephone:
Property details
No:
Road/Street:
Lot/s:
LP/PS:
Crown Allotment:
City/Suburb/Town:
Volume:
Section:
Parish:
Folio:
County:
Municipal District:
Builder
Builder:
Address:
Registration No:
Telephone:
Name
Category/Class
Registration No
Geoff Butler
Building Surveyor/Inspector
BS 1107/INU 1090
(if a registered domestic builder carrying out domestic building work attach details of the required insurance)
b) who were engaged to prepare documents forming part of the application for this permit3
Name
Category/Class
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Registration No
Demolition of a building
Removal of a building
Re-erection of a building
Other
Owner-builder5
I intend to carry out the work as owner-builder (circle where applicable):
Yes/ No
Yes/ No
Signature
I declare that the information is true and correct and that I have not previously appointed another Building Surveyor
for the works specified in this application.
Signature of owner or agent:
Date:
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