Development Application IDAS Forms 1 & 6 · OPW12/0360

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          ODD
     Privacy-the information collected in this form will be used by the Department of Infrastructure and Planning (DIP)in
     accordance with the processing and assessment of your appl)cation. Your personal details will not be disclosed for a purpose
     outside of the IDAS process, except where required by legislation (including the Right to Information Act 2009)or as required

     by Parliament. This information may be stored in a departmen~la, ase. The information collected will be retained as
     required by.the Public RecordsAct 2002.          ------
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     OFFICE USE ONLY
                                 oe\le\oprne
      Date received                              1 ~ SE           keferen~e   num




     NOTIFICATION OF ENGAG MENT OF A
                                            PR-ly’~~~ \lER
      To’                                        Cou   i.L.+h ~S private             the        certifier for the building work referred
                                               to in this application




                                                                                                                   Building
     Date of engagement        Name                                             BSA Certification license number
                                                                                                                   c1assificationjs




     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




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



                      7                                                                           Application details-IDAS form 1
                                                                                                    Version 1.0 18 December 2009