DBW Application - 30 Upper Pinbarren Creek Rd Pinbarren

 9) Has the portable long service leave levy been paid?
 □ Yes - a 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
 N Not applicable (e.g. building and construction work is less than $150,000 excluding GST)
 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
 EZI 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.des.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
 S 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 this development application, 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
 State

                                                                                                                         Page 3
                                                                                                DA Form 2 - Building work details
                                                                                                  Version 1.2— 7 February 2020