170903 ADAMS + SPARKES Minor Change Application · 51993.615.03

f) Existing building use/classification? (if applicable)
  1A
g) New building use/classification? (if applicable)
   1A
h) Relevant plans
Note: Relevant plans are required to be submitted for all aspects of this development application. For further information, see DA Forms Guide:
Relevant plans.
    Relevant plans of the proposed works are attached to the development application

17) What is the monetary value of the proposed building work?                      $ tbc

18) Has Queensland Home Warranty Scheme Insurance been paid?
   Yes – provide details below
   No
Amount paid                    Date paid (dd/mm/yy)                                        Reference number
$


PART 6 – CHECKLIST AND APPLICANT DECLARATION

19) Development application checklist
The relevant parts of Form 2 – Building work details have been completed                                           Yes
This development application includes a material change of use, reconfiguring a lot or                            Yes
operational work and is accompanied by a completed Form 1 – Development
application details                                                                                               Not applicable

Relevant plans of the development are attached to this development application
Note: Relevant plans are required to be submitted for all aspects of this development application. For further     Yes
information, see DA Forms Guide: Relevant plans.
The portable long service leave levy for QLeave has been paid, or will be paid before a                           Yes
development permit is issued                                                                                      Not applicable


20) Applicant declaration
    By making this development application, I declare that all information in this development application is true and
correct
   Where an email address is provided in Part 1 of this form, I consent to receive future electronic communications
from the assessment manager and any referral agency for the development application where written information is
required or permitted pursuant to sections 11 and 12 of the Electronic Transactions Act 2001
Note: It is unlawful to intentionally provide false or misleading information.
Privacy – Personal information collected in this form will be used by the assessment manager and/or chosen
assessment manager, any referral agency and/or building certifier (including any professional advisers which may be
engaged by those entities) while processing, assessing and deciding the development application.
All information relating to this development application may be available for inspection and purchase, and/or published
on the assessment manager’s and/or referral agency’s website.
Personal information will not be disclosed for a purpose unrelated to the Planning Act 2016, Planning Regulation 2017
and the DA Rules except where:
 such disclosure is in accordance with the provisions about public access to documents contained in the Planning
     Act 2016 and the Planning Regulation 2017, and the access rules made under the Planning Act 2016 and Planning
     Regulation 2017; or
 required by other legislation (including the Right to Information Act 2009); or
 otherwise required by law.
This information may be stored in relevant databases. The information collected will be retained as required by the
Public Records Act 2002.


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