Development Application Part 1 of 1 · OPW12/0386

ODD
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         classification/s




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
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 1.018 December 2009