DA form 2

 

e required by other legislation (including the Right to information Act 2009); or
« otherwise required by law.

This information may be stored in relevant databases. The information collected wil! be retained as required by the
Public Records Act 2002.

   

 

PART 7 -FOR COMPLETION BY THE ASSESSMENT MANAGER — FOR OFFICE
USE ONLY

 

 

‘ id {
Date received: Reference numbers: | |

 

NSU eM MMM sTeLico Memes ath (et

 

Ciassification(s) of approved buiiding work

 

 

Name QBCC Certification Licence QBCC Insurance receipt
number number

 

 

 

 

 

 

 

| Date chosen assessment m it manager engaged
| Contact number of chos

| Relevant licence number(s) ‘of chosen n assessment
manager

 

 

 

 

Additional information required by the local government

 

   

Contirm proposed Construction materials:

 

 

a Double brick (1 Steel CJ Curtain glass
External walls (1 Brick veneer 0 Timber (Aluminium

C1 Stone/concrete (J Fibre cement (Other

(J Timber i Steel (Aluminium

[] Other

[concrete Ss Timber

oO Slate/concrete _ i (Tiles Oo Fibre ceme
0 Aluminium UO Steel 0 Other i

 

 

 

 

 

 

 

 

 
 

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

Site area (m’) ~

 
 

 

Page 6
DA Form 2 — Development Application detaits
Version 1.1— 22 JUNE 2018