DA Form 1 - 134 Ferrells Rd, COOROY

"https://planning.dilgp.qld.gov.au/"uide: Relevant plans.
The portable long service leave levy for QLeave has been paid, or will be paid             Yes
before a development permit is issued (see 21)                                             Not applicable

25) Applicant declaration
By making this development application, I declare that all information in this development application
  is true and correct
Where an email address is provided in Part 1 of this form, I consent to receive future electronic
  communications from the assessment manager and any referral agency for the development
  application where written information is required or permitted pursuant to sections 11 and 12 of the
  Electronic Transactions Act 2001
Note: It is unlawful to intentionally provide false or misleading information.
Privacy – Personal information collected in this form will be used by the assessment manager and/or
chosen assessment manager, any relevant referral agency and/or building certifier (including any
professional advisers which may be engaged by those entities) while processing, assessing and
deciding the development application.
All information relating to this development application may be available for inspection and purchase,
and/or published on the assessment manager’s and/or referral agency’s website.
Personal information will not be disclosed for a purpose unrelated to the Planning Act 2016, Planning
Regulation 2017 and the DA Rules except where:
• such disclosure is in accordance with the provisions about public access to documents contained
     in the Planning Act 2016 and the Planning Regulation 2017, and the access rules made under the
     Planning Act 2016 and Planning Regulation 2017; or
• required by other legislation (including the Right to Information Act 2009); or
• otherwise required by law.
This information may be stored in relevant databases. The information collected will be retained as
required by the Public Records Act 2002.




PART 9 – FOR COMPLETION OF THE ASSESSMENT MANAGER –
FOR OFFICE USE ONLY

Date received:                                   Reference number(s):


Notification of engagement of alternative 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

QLeave notification and payment
Note: For completion by assessment manager if applicable
Description of the work
QLeave project number
Amount paid ($)                                                     Date paid (dd/mm/yy)
Date receipted form sighted by assessment
manager