Development Application part 1 of 2 IDAS FORMS 1 & 5 & COVER LETTER MCU12/0201

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DDD
NOTIFICATION OF ENGAGEMENT OF A PRIVATE CERTIFIER



                                                           Council. I have been engaged as the private certifier for the
To:
                                                           building work referred to in this application.


Date of                                                                         BSA Certification       Building
                          Name
engagement                                                                      license number          classificationls




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



                                                                                      Date receipted
                                              QLeave Project   Amount                 form sighted by Name of officer who
                    Description of the work                               Date paid
                                              Number           paid ($)               assessment        sighted the form
                                                                                      manager



              11                                               \e-
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.




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                                                                                               Application Details   -
                                                                                                                         IDAS form 1
                                                                                                 Version 1.0 18 December 2009