Applicant Details

Are you the Property Owner?

Yes

No but I have attached formal permission from the property owner

Formal permission

Are you part of a Community Title?

Yes

If yes please upload evidence of permission from all property owners

Applicant details

Applicant name

Address

Phone number

Is your postal address different from your property address?

Yes

Postal Address

Please complete if different to property address

Address

Suburb

Postcode

Location of Proposed Works

Address of Works

Street No. and Name

Suburb

Postcode

Does this application relate to a Development Application?

Yes

If Yes please provide the Development Application Number

Please note approval is granted subject to development application approval.

Please upload a sketch of the proposed works

PDF, PNG or JPEG (no larger than 3MG)

Certificate of Currency – Public Liability Insurance

Upload Certificate of Currency – Public Liability Insurance ($20M minimum)

Agreement and Declaration

Conditions Agreement

I have read and agree to the General Conditions outlined by the City of Holdfast Bay.

I understand that failure to comply may result in Council undertaking rectification works at my expense under Section 218 of the Local Government Act 1999.

Declaration

Name

Signature

Date

25%

File Test

Surface and Material Details

Declaration