D17129101DAForm2-Buildingworkdetails · 132007.12.8

 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)



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