DA Form 1 - 139 & 145 Musa Vale Rd, Cooroy · RAL26/0023

     PART 6 – INFORMATION REQUEST

        19) Information request under the DA Rules
            I agree to receive an information request if determined necessary for this development application
            I do not agree to accept an information request for this development application
        Note: By not agreeing to accept an information request I, the applicant, acknowledge:
         •    that this development application will be assessed and decided based on the information provided when making this development
              application and the assessment manager and any referral agencies relevant to the development application are not obligated under the DA
              Rules to accept any additional information provided by the applicant for the development application unless agreed to by the relevant
              parties
         •    Part 3 under Chapter 1 of the DA Rules will still apply if the application is an application listed under section 11.3 of the DA Rules or
         •    Part 2under Chapter 2 of the DA Rules will still apply if the application is for state facilitated development
        Further advice about information requests is contained in the DA Forms Guide.


     PART 7 – FURTHER DETAILS

        20) Are there any associated development applications or current approvals? (e.g. a preliminary approval)
            Yes – provide details below or include details in a schedule to this development application
            No
        List of approval/development              Reference number                       Date                                  Assessment
        application references                                                                                                 manager
            Approval
            Development application
            Approval
            Development application

        21) Has the portable long service leave levy been paid? (only applicable to development applications involving building work or
             operational work)
            Yes – a copy of the receipted QLeave form is attached to this development application
            No – I, the applicant will provide evidence that the portable long service leave levy has been paid before the
            assessment manager decides the development application. I acknowledge that the assessment manager may
            give a development approval only if I provide evidence that the portable long service leave levy has been paid
            Not applicable (e.g. building and construction work is less than $150,000 excluding GST)
        Amount paid                            Date paid (dd/mm/yy)                              QLeave levy number (A, B or E)
        $

        22) Is this development application in response to a show cause notice or required as a result of an enforcement
        notice?
            Yes – show cause or enforcement notice is attached
            No




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                                                                                                             DA Form 1 – Development application details
                                                                                                                           Version 1.6— 2 August 2024
Document Set ID: 25106968
Version: 1, Version Date: 28/08/2026