170903 ADAMS + SPARKES Minor Change Application · 51993.615.03

9) Has the portable long service leave levy been paid?
   Yes – the yellow local government/private certifier’s 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
Amount paid                        Date paid (dd/mm/yy)                  QLeave levy number (A, B or E)
$


10) 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

11) Identify any of the following further legislative requirements that apply to any aspect of this development application
         The proposed development is on a place entered in the Queensland heritage register or in a local
         government’s Local Heritage Register. See the guidance provided at www.ehp.qld.gov.au about the
         requirements in relation to the development of a Queensland heritage place
Name of the heritage place:                                         Place ID:


PART 4 – REFERRAL DETAILS

12) Does this development application include any building work aspects that have any referral requirements?
    Yes – the Referral checklist for building work is attached to this development application
    No – proceed to Part 5


13) Has any referral agency provided a referral response for this development application?
    Yes – referral response(s) received and listed below are attached to this development application
    No
Referral requirement                          Referral agency                           Date referral response



Identify and describe any changes made to the proposed development application that was the subject of the referral
response and the development application the subject of this form, or include details in a schedule to this development
application (if applicable)



PART 5 – BUILDING WORK DETAILS
14) Owner’s details
    Tick if the applicant is also the owner and proceed to 15). Otherwise, provide the following information.
Name(s) (individual or company full name)
Contact name (applicable for companies)
Postal address (P.O. Box or street address)
Suburb



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                                                                                       DA Form 2 – Development Application details
                                                                                                         Version 1.0—3 July 2017