D17129101DAForm2-Buildingworkdetails · 132007.12.8

                                                 Other
 Floor                                      ☒ Concrete                               Timber                               Other

                                                 Slate/concrete                      Tiles                                Fibre cement
 Roof covering                                   Aluminium
                                                                                  ☒ Steel                                 Other

 f) Existing building use/classification? (if applicable)


 g) New building use/classification? (if applicable)


 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?                      $3 M (about)

 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
 operational work and is accompanied by a completed Form 1 – Development                                          ☒ Yes
 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
                                                                                                                  ☒ Not applicable
 development permit is issued



 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.

                                                                                                                                              Page 5
                                                                                                           DA Form 2 – Development Application details
                                                                                                                             Version 1.0—3 July 2017