001A7F18.001

\        INTEGRATED PLANNING ACT 1997                                                                                          Part A, Version 3.1, 3 March 2008
         ‘Owner's consent (if applicable) _- further information is provided in the advice section at the end of the form    J                               J
         9.   Complete Table H for applications involving a material change of use; reconfiguration of a lot; work on land below high-water mark and
  :        .  not within a canal as defined under the Coasta! Protection and Management Act 1995; or work on rail corridor land defined under the
              Transport Infrastructure Act 1994 - provide details for each owner on a separate row, or on an attachment to this form if applicable.
                              |  Premises Owner's name/s               Details of the premises owned    |                   Le               Date consent |
         Table H              ;      and postal address     "|...   (street address or lot on plan description)  Owners Signature            was obtained
                                                                                                                 iP
                               Res Bella Pty Lid ACN 001                                                     tL fF)         OC
                       ‘fs                                                                            (Vee
                                                               Lots 1 - 5 on SP179879                                            oY        |/7OF/CF.
                                                                                                                  LA
                                                                                                      Ws eonser must
         * Owner’s signature cannot be provided on the form if you intend to submit the application electronically. Owner’s-eensént must be provided to the assessment manager on an
          attachment containing appropriate written documentation of the owner's consent. If the owner is a company, 8127 of the Corporations Act 2001 (Cwealth) details how a
          company may sign as owner. Templates for the provision of owner's consent are available on the IPA website .
         Attachments and supporting information (Complete Table | - Use a separate row for each type of attachment or information, including information required y
         funder this Part) Please énsure ail documentation submitted with this form, including other Parts of Form 1, of owner's Consent, etc, are securely attached to this Pari of the Form: .".”
                                    Description of attachment or information - |           Title on               a                             pa
                                                             a            _   ot   oo.  |.” Title (fapplicabley)                        Method of delivery to
          Table |               (og. Pesecatoventomen ls, “towing. pons)      |[1e4. Goneat Autry James StoetTrafe Report               assessment manager

  ©                  [2      | Plane and craigs                                a
         (Portable Long Service Leave (PLSL) levy (Applicable for certain building and construction work valued over $80,000 only)" -   To                  J
          10.   The Portable Long Service Leave Levy (PLSL) is not applicable to this application if any of the following apply: ( Tick box if applicable)
                [_] the application seeks a preliminary approval only;
                     the application is not for building and construction work under the Building and Construction Industry (Portable Long Service
                     Leave) Act 1991, section 3AA (e.g. the application is only for a change of use, or for the following types of work carried out solely for
                     farming purposes: land clearing, site preparation, earthworks, fences, fodder harvesting, clearing of encroaching vegetation, clearing of
                     regrowth, thinning vegetation or controlling weeds or pests);
                 [_] all costs, that relate to the work both directly and indirectly, are less than $80,000, inclusive of GST; or
                 [_] the work is being carried out under an owner-builder permit issued under the Queensland Building Services Authority Act 1991 -
                     Complete and submit a QLeave Notification and Payment Form (no payment required if owner-builder permit number stated). The receipted form must be
                     sighted by the assessment manager before a development permit can be given.

          11.    Is payment of a PLSL levy applicable to this application? (Refer to Q10 and the Advice below for more information)?
                         No - End of Part A
 ©                 [_}   Yes - Answer Q12 below
          OFFICE USE ONLY (For use by the Assessment Manager / Private Certifier) (Optional)
                                             .                          Receiving officer's                               Reference
                                  Date  rece

           -      7         * NOTIFICATION‘OF ENGAGEMENT OF PRIVATE CERTIFIER                                              ©                       eh
          To: [fiat | have been engaged as the private certifier for the building work referred to in this application.
          Date of                                              a   eB                                              ve itiaveempee  | '   puineiinn sdnceiffenttem ie « |
                                .               , | “      5 Name 5      Oe       .       cB °            . BSA Certification number , Building classifications at