Sun Lagoon IDAS Form 01 · OPW12/0598

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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 stored in a departmental database. The information collected will be retained as
required by the Public Records Act 2002.



OFFICEUSE ONLY
 Date received       ____________                        1 Reference numbers


NOTIFICATIONOF ENGAGEMENTOF A PRIVATECERTIFIER
 To   I                                  I Council. I have been engaged as the private certifier for the building work referred
                                         . to in this application


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




QLEAVENOTIFICATIONAND 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 Planning Act 2009 (SPA) is adminisjered by the Department of Infrastructure and Planning. This form and
 all other required application materials should be s nt to your assessment manager and any referral agencies.


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