DA Form 2

9) Has the portable long service leave levy been paid?
    Yes – a copy of the receipted QLeave form is attached to this development application
    No – I, the applicant will provide evidence that the portable long service leave levy has been paid before the
    assessment manager decides the development application. I acknowledge that the assessment manager may
    give a development approval only if I provide evidence that the portable long service leave levy has been paid
    Not applicable (e.g. building and construction work is less than $150,000 excluding GST)
Amount paid                        Date paid (dd/mm/yy)                 QLeave levy number (A, B or E)
$

10) Is this development application in response to a show cause notice or required as a result of an enforcement
notice?

    Yes – show cause or enforcement notice is attached

    No


11) Identify any of the following further legislative requirements that apply to any aspect of this development
application
    The proposed development is on a place entered in the Queensland Heritage Register or in a local
    government’s Local Heritage Register. See the guidance provided at www.des.qld.gov.au about the
    requirements in relation to the development of a Queensland heritage place
Name of the heritage place:                                         Place ID:


PART 4 – REFERRAL DETAILS
12) Does this development application include any building work aspects that have any referral requirements?
    Yes – the Referral checklist for building work is attached to this development application
    No – proceed to Part 5

13) Has any referral agency provided a referral response for this development application?
    Yes – referral response(s) received and listed below are attached to this development application
    No
Referral requirement                                           Referral agency                   Date referral response




Identify and describe any changes made to the proposed development application that was the subject of the
referral response and this development application, or include details in a schedule to this development application
(if applicable)




PART 5 – BUILDING WORK DETAILS
14) Owner’s details
    Tick if the applicant is also the owner and proceed to 15). Otherwise, provide the following information.
Name(s) (individual or company full name)        Katie Baker
Contact name (applicable for companies)
Postal address (P.O. Box or street address)      69 Gradys Lane
Suburb                                           Kin Kin
State                                            Qld
Postcode                                         4571
Country