Skmbt_C280-12111513221

i!

NOTIFICATION OF ENGAGEMENT OF A PRIVATE CERTIFIER

 

 

 

 

 

To: Council. | have been engaged as the private certifier for the
. building work referred to in this application.

Date of Name BSA Certification Building

engagement license number Classification/s

 

 

 

 

 

QLEAVE NOTIFICATION AND PAYMENT (for completion by assessment manager or private certifier if applicable)

 

Date receipted
a QLeave Project {Amount (4 {form sighted by|Name of officer who
Description of the work Number paid ($) Date paid assessment _|sighted the form

manager

 

 

 

 

 

 

 

 

 

 

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 Betas - IDAS Yorn 1
Version 1.0 18 December 2069