DA form 2

 
     

9) Has the portable long service leave levy been ie
C Yes — the yellow local government/private certifier’s copy of the receipted QLeave form is attached to this
development application

(1 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. | acknowledge that the assessment manager may give
elopment approval only if | provide evidence that the portable long service leave levy has been paid

4] 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
b i Py f 4

notice?
oes — show cause or enforcement notice is attached
No

       

 

CDM eM EM Colm Mau cIm (ctl tV Meisel cTat MLC lee ale) a Col pntaeettsl-fer alm aiicee(A yl ele stit

 

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.qid.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)
oO Yes — the Referral checklist for building work is attached to this development application
[EY No — proceed to Part 5

Does this development application include any building work aspects that have any referral requirements?

 

 
    

13) Has any referral agency provided a referral response for this development application?
U Yes — referral response(s) received and listed below are attached to this development application
CINo

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

C Tick if the applicant is also the owner and proceed to 15), Otherwise, provide the following information.
Name(s) (individual or company full name) LY WirOman
Contact name (applicable for companies)

 

 

 

 

 

 

 

Page 3
DA Form 2 — Development Application details
Version 1.1— 22 JUNE 2018