170903 ADAMS + SPARKES Minor Change Application · 51993.615.03

PART 7 – FOR OFFICE USE ONLY - FOR COMPLETION BY THE ASSESSMENT
MANAGER

 Additional building details required for the Australian Bureau of Statistics
 Existing building use/classification? (if applicable)
 New building use/classification?
 Site area (m2)                                                      Floor area (m2)


 Additional information required by the local government
 Confirm proposed construction materials:
                                          Double brick                  Steel                        Curtain glass
 External walls                           Brick veneer                  Timber                       Aluminium
                                          Stone/concrete                Fibre cement                 Other
                                          Timber                        Steel                        Aluminium
 Frame
                                          Other
 Floor                                    Concrete                      Timber                       Other
                                          Slate/concrete                Tiles                        Fibre cement
 Roof covering
                                          Aluminium                     Steel                        Other


 Date received:                              Reference numbers:

 For completion by the building certifier
 Classification(s) of approved building work               QBCC Insurance receipt       QBCC Certification Licence
                                                           number                       number




 Notification of engagement of alternate chosen assessment manager
 Prescribed assessment manager
 Name of chosen assessment manager
 Date chosen assessment manager engaged
 Contact number of chosen assessment manager
 Relevant licence number(s) of chosen assessment
 manager

The Planning Act 2016, the Planning Regulation 2017 and the DA Rules are administered by the Department of
Infrastructure, Local Government and Planning. This form and all other required development application materials should
be sent to the assessment manager.




                                                                                                                          Page 6
                                                                                       DA Form 2 – Development Application details
                                                                                                         Version 1.0—3 July 2017