Development application part 1 of 2 IDAS forms 1 & 6 · OPW13/0914

                                                                 BSA Certitication license           Building
Date of engagement    Name
                                                                 number                              classiticationls




QLEAVE NOTIFICATION AND PAYMENT (For completion by assessment manager or private certifier if
applicable.)
                                                                                  Date receipted
                               QLeave project      Amount paid                   form sighted by     Name of officer who
Description of the work                                              Date paid
                               number              ($)                           assessment          sighted the form
                                                                                 manager

                                                Q ’]O~
                                                   ~ \\34-~’f-~
The Sustainable Planning Act 2009 is administered by the Department of State Development, Infrastructure and
Planni ng. This form and all other required application materials should be sent to your assessment manager and any
referral agencies.




8                                                                                            IDAS form 1-Applicafion details
                                                                                              Version 2.017 December 2012