DA Form 2

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

Date received:                                Reference numbers:

For completion by the building certifier
Classification(s) of approved building work
1a
Name                                                       QBCC Certification Licence         QBCC Insurance receipt number
                                                           number
Jack Green                                                 A48824

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

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

QLeave notification and payment
Note: For completion by assessment manager if applicable

Description of the work
QLeave project number
Amount paid ($)                                                     Date paid (dd/mm/yy)
Date receipted form sighted by assessment manager
Name of officer who sighted the form


Additional building details required for the Australian Bureau of Statistics
Existing building use/classification? (if applicable)
New building use/classification?
Site area (m2) 35092                                       Floor area (m2)       0




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                                                                                           DA Form 2 – Development Application details
                                                                                                       Version 1.2 — 7 February 2020