180093 - DA Form 2

 Floor                            ☑ Concrete                   ☐ Timber                       ☐ Other
                                  ☐ Slate/concrete             ☐ Tiles                        ☐ Fibre cement
 Roof covering
                                  ☐ Aluminium                  ☑ Steel                        ☐ Other

 Date received:   14/3/2018             Reference numbers:     180093

 For completion by the building certifier
 Classification(s) of approved building work         QBCC Insurance receipt           QBCC Certification Licence
                                                     number                           number
 6                                                   Not applicable                   A621704


 Notification of engagement of alternate chosen assessment manager
 Prescribed assessment manager
 Name of chosen assessment manager
 Date chosen assessment manager engaged
 Contact number of chosen assessment manager
 Relevant licence number(s) of chosen assessment
 manager

The Planning Act 2016, the Planning Regulation 2017 and the DA Rules are administered by the Department of
Infrastructure, Local Government and Planning. This form and all other required development application materials should
be sent to the assessment manager.




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                                                                                    DA Form 2 – Development Application details
                                                                                                      Version 1.0—3 July 2017