<p>KZB Building Surveying Services P/L Building Permit & Inspection Building Surveyors & Construction Consultants Fire Engineering Reports Alternative Solutions Construction Dispute Resolutions Construction Contracts</p><p>APPLICATION FOR PERFORMANCE ASSESSMENT</p><p>To: KZB Building Surveying Services. I/we request your services to undertake performance assessment to the design with respect to the following Property. The services requested, but not to limited to, for consulting purposes.</p><p>From: Owner/Agent of owner ______Postal Address: ______Postcode: ______Contact Person: ______Telephone: ______</p><p>Property Details: Number:______Street/Road:______City/Suburb/Town______Lot/s:______LP/PS:______Volume:______Folio:______Crown Allotment:______Section:______Parish:______County:______Municipal District:______</p><p>Proposed use of building intended for Performance Assessment: ______</p><p>Nature of Performance Assessment: The use of Clause A2.2 of the Building Code of Australia may apply to the following: Report from Registered Testing Authority______Certification of Accreditation______Certificate of Compliance from Engineer______Scientific Services Laboratory (SSL) Certificate of Conformity______Product Listing Data Sheet______Assessment from Expert Judgement______Comparison to Deemed – to – Satisfy Provisions____ Assessment method by Verification______</p><p>Building Classification: (Class 1-10, Classes 2-9) (i) ______(ii) ______(iii) ______</p><p>475 Main Street, Mordialloc. VIC. 3195. PH: (03) 9587 3214 FAX: (03) 9587 1723 E.MAIL: [email protected] Web site: www.kzbbuilding.com.au KZB Building Surveying Services Building Permit & Inspection Building Surveyors & Construction Consultants Fire Engineering Reports Alternative Solutions Construction Dispute Resolutions Construction Contracts</p><p>Building Code of Australia Clause(s) for Performance Assessment: (i) ______(ii) ______(iii) ______(iv) ______(v) ______</p><p>Reason for Requesting Performance assessment: ______</p><p>Sincerley,</p><p>Name: (Print Name) ______</p><p>Signature of Owner Agent______</p><p>Date:______</p><p>2</p>