Development Application - Part 1 of 2 - Covering Letter, IDAS Forms 1, 6 & 28, Title Search & Compliance Certificate 15 · OPW12/0511

      ODD
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 legislation (includingthe Right to Information Act 2009)or as required

by Parliament. This information may be stored in a departmental database. The information collected will be retained as
required by the PlJblic Records Act 2002.



OFFICE USE ONLY

 Date received                                             Reference numbers



NOTIFICATION OF ENGAGEMENT OF A PRIVATE CERTIFIER

 To
      I                                 I   Cou neil. I have been engaged as the pr;vate eertmerfor the bu ild;ng work referred
                                            to in this application




Date of engagement
                                                                                                          Building
                          Name                                         BSA Certification license number
                                                                                                          classification Is




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




 The SlJstainable PlanningAct 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.




              7                                                                          Application details-IDAS form 1
                                                                                           Version 1.0 18Oecember 2009