Development Application part 1 of 2 - Cover Letter & IDAS Forms MCU13/0078

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
                                                                                     manager
 NEW DWELLING                                      $                                                    D.Grehan




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.




8                                                                                              IDAS form 1-Applicat on details
                                                                                                 Version 2.0 17 December 2012