Development Application Part 1 of 2 Application Form MCU12/0047

DDD
12. Does the proposal include new building work or operational work on the premises? (including any
    services)

D No ~Yes           -
                        ensure the nature, location and dimensions of   proposed works are included in plans submitted

13. Is the payment of a portable long service leave levy applicable to this application? (refer to the notes at the
    end of this form for more information)


~ No    -
            Go to question 15                  DYes


15. Has the local government agreed to apply a superseded planning scheme to this application under
    section 96 of the Sustainable Planning Act 20091



~    No

DYes provide details below
            -




16. List below all of the forms and supporting Information that accompany this application (include all IDAS
forms, checklists, mandatory supporting information etc. that will be submitted as part of this application. Note: this
question does not apply for applications made online using Smart eDA)

                                                                                                   Method of lodgement to
                                  Description of attachment or title of attachment                   assessment manager


                1   IDAS Form 5 and IDAS Checklists 1 & 2                                          over the counter




                    Town Planning Report and Code Assessment prepared by KHA
                2                                                                                  over the counter
                    Development Managers


                3       Architectural Plans prepared by Bark Design Architects                     over the counter




117. Applicant’s declaration
 I’V’I By making this application, I declare that all information in this application is true
                                                                                              and correct (note: it is
 ~ unlawful to provide false or misleading information).




                                                                                               Application Details   -
                                                                                                                         IDAS form 1
                                                                                                 Version 1.0 18 December 2009