Development Application part 1 of 2 - Idas Forms 1 & 5 247-251 Gympie Tce Noosaville · MCU10/2022

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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 application. 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) oF as required
by Parliament. This information may be stored in a departmental database. The information collected will be retained as

required by the Public Records Act 2002.

OFFICE USE ONLY . ee
Date received . Reference numbers [

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 :

 

 

 

 

 

 

Building
classification/s

Date of engagement Name BSA Certification license number

 

 

 

 

 

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

 

oar : : QLeave Project Amount paid . form sighted by |Name of officer who
Description of t! k :
escription of the wor Number ($y Date 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.

why rit {DAS farm 1
Version 1.0.18 Decetnbet 2009

 

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