Hereby appoint Robert Hartley trading as Yarra Building Surveyor Group Pty Ltd of Shop 3 / 260 Main Street, Lilydale, AIBS membership number 4129 Building Practitioners
Board registration no. BS25753 to act as the relevant building surveyor (hereafter referred to as “RBS” pursuant to the provisions of the Building Act 1993 (hereafter referred to
as “Act”) and Building Regulations 2005 (here after referred to ass “Regulations”) and shall pay the fees as nominated hereunder for proposal as set out in the fee proposal. I
have not appointed another relevant building surveyor for these works. I make this appointment in my capacity as the owner/agent for this site. I am authorised by the owner of
the building or land in writing to make this application on their behalf, pursuant to Section 248 of the Building Act 1993 (f or agent of the owner only). This authorisation includes
any application, including permit application, appeal or referral under this act.