DA Form 2

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


 g) New building use/classification? (if 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?                      $ 100,000.00

 18) Has Queensland Home Warranty Scheme Insurance been paid?
    Yes – provide details below
    No
 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                                          Yes
 This development application includes a material change of use, reconfiguring a lot or                            Yes
 operational work and is accompanied by a completed Form 1 – Development
 application details                                                                                               Not applicable

 Relevant plans of the development are attached to this development application
 Note: Relevant plans are required to be submitted for all aspects of this development application. For further    Yes
 information, see DA Forms Guide: Relevant plans.
 The portable long service leave levy for QLeave has been paid, or will be paid before a                           Yes
 development permit is issued                                                                                      Not applicable


 20) Applicant declaration
     By making this development application, I declare that all information in this development application is true and
 correct
    Where an email address is provided in Part 1 of this form, I 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 Electronic Transactions Act 2001
 Note: It is unlawful to intentionally provide false or misleading information.
 Privacy – Personal 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:
 • 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
 • 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 will be retained as required by the Public
 Records Act 2002.


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                                                                                                          DA Form 2 – Development Application details
                                                                                                                            Version 1.0—3 July 2017