DA form 2

 

Postal address (P.O. Box or street address) Gy A cok Goe\ of tA

 

 

 

 

Suburb Mr Coolla
State RQLoO

Postcode S73

Contact number CUE Fo 9O 2S

 

Email address (non-mandatory)

 

Mobile number (non-mandatory)

 

 

Fax number (non-mandatory)

 

15) Builder's details

 

(1 Tick if a builder has not yet been engaged to undertake the work and proceed to 16). Otherwise provide the
following information.

 

Name(s) (individual or company full name) Ome Wicd CTy Wo

 

Contact name (applicable for companies) &eso Cap Mare wd
QBCC licence or owner — builder number MS ‘

 

 

    

Postal address (P O. Box or street address)

 

 

 

 

 

 

 

Suburb

State

Postcode as 7z

Contact number Obhe7 180 (SS

Email address (non-mandatory) andy fee anbe ‘ id : nek a
J

Mobile number (non-mandatory)

 

Fax number (non-mandatory)

 

 

 

 

16) Provide details about the proposed building work

 

a) What type of approval is being sought?
[evelopment permit
Cileaniaes approval _

at is the level of assessment?

(1 Code assessment
CJ impact assessment (requires public notification)

c) Nature of the proposed building work (tick all applicable boxes)

 

   

 

 

C1 New building or structure Kepairs, alterations or additions
{J Change of building classification {involving building work} (1 Swimming pool and/or pool fence
(C1 Demolition (J Relocation or removal

 

d) Provide a description of the work below or in an attached schedule.

 

Ko pes ech AP Mery

e) Proposed construction materials

 

 

 

 

 

CJ Double brick Steel C] Curtain glass
External walls (J Brick veneer 1 Timber (1 Aluminium

(7 Stone/concrete C1] Fibre cement CD Other |
pad [A Timber [Steel D1 Aluminium \

(Other

 

 

Page 4
DA Form 2 - Development Application details
Version 1.1— 22 JUNE 2018