Form1

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      X 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 (see 21))                                                                              X Not applicable

25) Applicant declaration
X By making this development application, I declare that all information in this development application is true and
correct
X 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 relevant 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.




PART 9 – FOR OFFICE USE ONLY

Date received:                                         Reference number(s):

Notification of engagement of alternative assessment manager
Prescribed assessment manager
Name of chosen assessment manager
Date chosen assessment manager engaged
Contact number of chosen assessment manager
Relevant licence number(s) of chosen assessment
manager

QLeave notification and payment
Note: For completion by assessment manager if applicable
Description of the work
QLeave project number
Amount paid ($)
Date paid
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                                                                                                           DA Form 1 – Development Application details
                                                                                                                         Version 1.1— 22 JUNE 2018