DA form 2

 

Floor 1 Concrete (2 Timber LD Other

UJ Slate/concrete O Tiles C1 Fibre cement
1 Aluminium Stee! OC Other

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

 

Roof covering

 

 

 

 

g) New building use/classification? (i 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? [Ry $s CO 6600
7

 

 

18) Has Queensland Home Warranty Scheme Insurance been Pete
Yes - provide details below

0
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 Ef Yes

This development application includes a material change of use, reconfiguring a lot or [bes
operational work and is accompanied by a completed Form 1 — Development CI Not ficabl
application details eee
Relevant plans of the development are attached to this development application

Note Relevant plans are required to be submitted for alf aspects of this development application. For further [ves
information, see DA Forms Guide. Relevant plans.

The portable long service leave levy for QLeave has been paid, or will be paid before a LL¥és
development permit is issued (Not applicable

 

 

 

 

 

 

By making this development application, | declare that all information in this development application is true and

correct

(0 Where an email address is provided in Part 1 of this form, | 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 E/ectronic Transactions Act 2001

Note. it is unlawful to intentionally provide false or misleading information

Privacy —pPersonal 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.

Personal information will not be disclosed for a purpose unrelated to the Planning Act 2016, Planning Regulation 2017

and the DA Rules except where:

e _such disclosure is in accordance with the provisions about public access to documents contained in the Planning
Act 2016 and the Planning Regulation 2017, and the access rules made under the Planning Act 2016 and Planning
Regulation 2017; or

 

 

 

 

Page 5
DA Form 2 — Development Application details
Version 1.1— 22 JUNE 2018