14623 DA - Change a development approval [As Published] · 131998.981605.2

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Privacy—the information collected in this form will be used by the Department of Infrastructure and Planning (DIP) in
accordance with the processing and assessment of your application. Your personal details will not be disclosed for a purpose
-outside of the IDAS process, except where required by legistation (including the Right to Information Act 2009) or as required
:by-Parliament. This information may be stored ina departmerital database. The information collected will be retained as

‘required by the Public Records Act 2002.

“OFFICE USE ONLY

 

 

Date received

 

 

 

‘NOTIFICATION OF ENGAGEMENT OF A PRIVATE CERTIFIER ;
Council. ! have been engaged as the private certifler for the building work referred.

To

 

 

 

to in this application

Reference numbers

 

 

 

 

 

Date of engagement Name

Buildi
BSA Certification license number uN ung .
classification/s

 

 

 

 

 

 

QLEAVE NOTIFICATION AND PAYMENT (for completion by assessment manager or private certifier if applicable) ee
Date receipted
Description of the work Qleave Project Amount paid Date paid form sighted by Name of officer who
($) assessment sighted the form
manager

 

 

 

 

 

 

 

 

 

The Sustainable Planning Act 2009(SPA) is administered by the Department of Infrastructure and Planning. This form and
all other required application materials should be sent to your assessment manager and any referral agencies.

Application details—IDAS form 1
Version 1.0 18 December 2009

 

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