DA Form 1 - 75 Williams St

Supporting information addressing any applicable
assessment benchmarks is with the development
application
Note: This is a mandatory requirement and includes any relevant
                                                                                       Yes
templates under question 23, a planning report and any technical
reports required by the relevant categorising instruments (e.g. local
government planning schemes. State Planning Policy, State
Development Assessment Provisions). For further information, see DA
Forms Guide: Planning Report Template.
Relevant plans of the development are attached to this
development application
Note: Relevant plans are required to be submitted for all aspects of this              Yes
development application. For further information, see DA Forms Guide:
Relevant plans^
The portable long service leave levy for QLeave has                              Yes
been paid, or will be paid 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