Development Application - Part 1 of 2 - Covering Letter, Decision Notice and IDAS Forms 1 & 6 - OPW13/0142

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 (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
                                                                                   manaqer

  DEMOLISH EXISTING           E084029             9957              27/04/2011     27/04/2011                     D.Grehan
  DWELLING & NEW
  DWELLING & POOL




The Sustainable Planning Act 2009 is administered by the Department of State Development, Infrastructure and

Planning. This form and all other required application materials should be sent to your assessment manager and any
referral agencies.




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