Development Application Part 1 of 2 - IDAS Forms 1 and 6 - OPW13/0308

OFFICE USE ONLY

 Date received                                        Reference numbers


NOTIFICATION OF ENGAGEMENT OF A PRIVATE CERTIFIER

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

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




QLEAVE NOTIFICATION AND PAYMENT (Forcompletion by assessment manager or private certifier if
aQPlicable.).




                                                                                    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
 Jetty                                            $                                                    D.Grehan




The Sustainable Planning Act 2009 is administered by the Department of State Development, Infrastructure and
Planning. This form and a" other required application materials should be sent to your assessment manager and any
referral agencies.




8                                                                                             IDAS form 1-Application detatls
                                                                                                Vers on 2.017 December 2012