00156B56.001

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   .         INTEGRATED PLANNING ACT 1997                                                                                  Part B, Version 2.2, 4 September 2006
             Residential work cont                 9.   For a proposal involving dwelling units, indicate each of the following (if appiicabie)
                                                            a) Number of existing dwelling units             [6
                                                            b) Number of dwelling units to be demolished     [6                   iss
                                                            c) Number of new / additional self-contained dwelling units     [fe]
             BSA insurance is not required where the 10. Whatis the Building Services Authority   (BSA) Insurance receipt number (if applicable)
             maces eneuneo
             Bulers detas kom)                     [tt
             If more than one builder, attach details e.g.             7
             builder X for the house and builder Y for the Contactdetais |
            ea                                            BSALicence number        [CSCSCS™S™S™~S~SCS
                                                          If owner-builder, state owner-builder number    PO
                                                    12:  Is the project “owner — builder"?
            ;                                            [x] NO                                                                                            .
                                                         (1) YES - provide “owner-builder” number below

           “Owner's details                         13.    Name (in tu        Karabin P/L; RJ Selkirk P/L; Cammeravy Investments P/L; The Body
      @ ans ivematon is Te         xi       ,                     (           Corporate Sandpiper Noosa Heads
            _ applications for single de lass 1a                        7
            The nominated owner will receive a copy of
            , the decision notice and approved plans.
            , Release of owner's details            14.  Does the owner agree to the release of their name & the land address for marketing purposes?
            : aegaied Planning Act 1997 s 5.7.2 and      0 NO                                    mR YES
           ‘                                        15.  Does the owner have reasons for withholding development information (about/for example)
                                                         plans, drawings and specifications for plans?
                                                                                                                                                           u
                                                         [1 NO                                  [YES                                                       ;
                                                         If YES, give reasons why the development information relates to a sensitive security issue or is
                                                         of a purely private nature about an individual.
                                                                                                                                          ee
             Portable Long Service Leave levy (if | 16.  Is payment of a Portable Long Service Leave (PLSL} levy applicable to the proposal?
     @       applicable)                                 & YES
            ' Prior to issuing a development penmit for the
            _works, the assessment manager is required   CNo                                                                                               .
            " by faw to “sight” an approved form, issued by
            ‘ QLeave, which signifies that the PLSL levy
             has been paid.
             PLEASE NOTE: This application cannot be accepted unless accompanied by Part A of Form 1. The assessment manager can refuse to accept an application that, at the
                               time of lodgement, fails to provide all applicable information required by Part A and any other relevant part of Form 1.

            OFFICE USE ONLY fappiicabie to assessment manager or private certifier)

             (i) | What is the building classification?

             (ii)  ts a PLSL levy applicable in this instance?                   [JNO                   [] YES - complete Ovi)
            (iii) Has the approved form (issued by QLeave and which signifies that the PLSL levy has been paid) been sighted by the assessment
                  manager / private certifier at the time of lodgement of this application?
                   CJ NO                             [_] YES - provide receipt details below