Development Application part 1 of 1 IDAS Forms 1 & 5 MCU11/0204

NOTIFICATION OF ENGAGEMENT OF A PRIVATE CERTIFIER

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


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




QLEAVE NOTIFICATION AND PAYMENT (for completion by assessment manager or private certifier if applicable)


                                                                              Date receipted
                                      QLeave Project   Amount                 form sighted by Name of officer who
              Description of the work                             Date paid
                                      Number           paid ($)               assessment      sighted the form
                                                                              manager




The Sustainable Planning Act 2009 (SPA) is administered by the Department of Infrastructure and Planning. This
form and all other required application materials should be sent to your assessment manager and any referral
agencies.