23616 DA - Changes Application [As Published] · 132003.221132.7

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NOTIFICATION OF ENGAGEMENT OF A PRIVATE CERTIFIER

 

 

 

 

 

To: Council. | have been engaged as the private certifier for the
. building work referred to in this application.
Date of N BSA Certification Building
Jame : an
engagement license number classification/s

 

 

 

 

 

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

 

 

Description of the work

Number

Date receipted

QLeave Project |Amount form sighted by|Name of officer who

Date paid

paid ($) assessment _jsighted 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.

 

Application Details - IDAS form 1
Version 1.0 18 December 2009