Re-lodged application MCU16/0121

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                                                                      Department   01 Intra!.truuure.     loeJI GOVl'rnment "nd Planning




Question 12
• The portable long service leave levy need not be paid when the application is made, but the Building and
  Construction Industry (Portable Long Service Leave) Act 1991 requires the levy to be paid before a development
  permit is issued.
• Building and construction industry notification and payment forms are available from any Queensland post offICe or
  agency. on request from QLeave. or can be completed on the QLeave website at www.qleave.qld.gov.au. For
  further information contact QLeave on 1800803481 or visit www.qleave.qld.gov.au.


Privacy-The    information collected in this form will be used by the Department of Infrastructure, Local Government
and Planning (DILGP), assessment manager. referral agency andlor building certifier in accordance with the
processing and assessment of your application. Your personal details should not be disclosed for a purpose outside of
the IDAS process or the provisions about public access to planning and development information in Ihe Susteineble
Planning Act 2009, except where required by legislalion (including Ihe Right to Information Act 2009) or as required by
Parliament. This information may be stored in relevant databases. The infonmalion collected will be retained as
required by the Public Records Act 2002.


OFFICE USE ONLY

 Dale received                                       I Reference numbers
                   ------------
NOTIFICATION OF ENGAGEMENT OF A PRIVATE CERTIFIER

 To                                                      Council. I have been engaged as the private certifier for the

        ----------------                             I   building work referred to in this application

                                                                       BSA Certification license                Building
 Date of engagement        Name
                             -                                         number                                   classlflcationls




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




The Sustainable Planning Act 2009 is administered by the Department 0/ In/rastructure. Local Government and
Planning. This form and all other required applicalion materials should be sent to your assessment manager and any
referral agency.




                                                                                                        IDAS form 1 Al      r    ( •• '
                                                                                                            Vt"I 0'1 J 2 1 AUQtJst ./01&