Development Application Part 1 of 1 · OPW12/0385

      ODD
Privacy-the information collected in this form will be used by the Department of Infrastructure and Planning (DIP)in
accordance with the processing and assessment of your application. Your personal details will not be disclosed for a purpose
outside of the IDAS process, except where required by legislation (including the Right to Information Act 2009) or as required

by Parliament. This information may be stor                          atabase. The information collected will be retained as

required by the Public Records Act 2002.
                                                  Develo ment C

OFFICE USE ONLY                                                 26 SEP 2012
 Date received                                              Reference numbers

                                                           aroochydore
NOTIFICATION OF ENGAGEMENT OF A PRI ATE CERTIFIER

 To
      I                                 I   Cou n cil. I have been engaged as the private certifier for the bu ilding work refe rred
                                            to in this application




                                                                                                              Building
Date of engagement        Name                                           BSA Certification license number
                                                                                                              c1assification/s




QLEAVE NOTIFICATION AND PAYMENT (for completion by assessment manager or private certifier if applicable)
                                                                                           Date receipted

                                  QLeave Project          Amount paid                      form sighted by     Name of officer who
Description of the work                                                       Date paid
                                  Number                  ($)                              assessment         sighted the form
                                                                                           manager




 The Sustainable PlanningAct 2009(SPA)is administered by the Department of Infrastructure and Planning. This form and
 all other required application materials should be sent to your assessment manager and any referral agencies.




              7                                                                             Application details-IDAS form 1
                                                                                              Version 1.0 18December 2009