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Form 17A Advice Request State Development Assessment Unit Version: 1.2 (October 2020) 1

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Form 17A Advice Request State Development Assessment Unit Version: 1.2 (October 2020) 1 Pre-lodgement Form 17A Advice Request State Development Assessment Unit Version: 1.2 (October 2020) 1. Proposed Development Land: (House number, street name, town/suburb) A copy of each Certificate of Title must be provided with this form Certificate of Title Lot No.: Location No.: Plan or diagram: Volume: Folio: Certificate of Title Lot No.: Location No.: Plan or diagram: Volume: Folio: Certificate of Title Lot No.: Location No.: Plan or diagram: Volume: Folio: Certificate of Title Lot No.: Location No.: Plan or diagram: Volume: Folio: Planning Schemes: Name of planning scheme(s) that applies to the prescribed land Description of Proposed Development Anticipated cost of proposed development (excl. gst) $ Project name: 2. Applicant details The applicant is the person with whom the WAPC will correspond and the person to whom the determination will be sent. *By completing this notice, I declare that all the information provided is true and correct. Company: Contact person: Postal address: Town / suburb: Postcode: Phone number/s: Email: Applicant signature: Name and position: Date: (if signing on behalf of a company or agency) The information and plans provided with this application may form part of an agenda as part of the reporting process. Page 1 Pre-lodgement Form 17A Advice Request State Development Assessment Unit Version: 1.2 (October 2020) 3. Landowner Details To be completed and signed if landowner is different from applicant. * By completing this notice, consent is provided to submitting this application. * If there are more than two landowners, please provide all relevant information on a separate page. * Signatures must be provided by all registered proprietors or by an authorised agent as shown on the Certificate of Title. * Alternatively, a letter of consent, which is signed by all registered proprietors or by the authorised agent, can be provided. * Companies, apart from sole directors, are required to provide signatories for two directors, a director and the company seal or a director and a company secretary. Name / company: Contact details: Email: Phone: Address: Street Number/PO Box number, street name, suburb, state, postcode Town / suburb: Postcode: State: Name/s and title/s: (Select one) Landowner Sole Director Director Additional Landowner Additional Director Secretary Signature/s: Date: 4. Assessment Pathway 1. Please identify the anticipated assessment pathway for the proposed development: (tick one or more of the following) Direct application made to the WAPC for approval as Significant Development s.271 Development within the metropolitan region1 that has an estimated cost of $20 million or more; or Development outside the metropolitan region1 that has an estimated cost of $5 million or more or Notification to the Minister for Planning for application of State or regional importance (s.272). 1The metropolitan region incorporates the following local government areas: City of Armadale City of Gosnells City of Perth City of Vincent Town of Cambridge City of Bayswater City of Joondalup City of Rockingham City of Wanneroo Town of Claremont City of Belmont City of Kalamunda City of South Perth Shire of Mundaring Town of Cottesloe City of Canning City of Kwinana City of Stirling Shire of Peppermint Grove Town of East Fremantle City of Cockburn City of Melville City of Subiaco Shire of Serpentine-Jarrahdale Town of Mosman Park City of Fremantle City of Nedlands City of Swan Town of Bassendean Town of Victoria Park The information and plans provided with this application may form part of an agenda as part of the reporting process. Page 2 Pre-lodgement Form 17A Advice Request State Development Assessment Unit Version: 1.2 (October 2020) 5. Information to be Submitted Please provide an overview of the development, including: • the proposed land uses; • any relevant development application or design review background or history of the site; • any concept drawings, site analysis or other relevant technical documents that have been prepared to inform this development proposal. Summarise how the proposal has had regard to: • The purpose and intent of the local planning scheme, and • The need to ensure orderly and proper planning, and the preservation of amenity of the locality, and • The need to facilitate development in response to the economic effects of COVID-19 pandemic, and • Any relevant State planning policies and any other relevant policies of the Commission. Please provide a list of the names and companies of the consultant team where known. * Information can be provided below or attached separately to this form. 6. Pre-consultation Information Has any preliminary consultation with any person, Minister, local government or State agency been undertaken prior to submitting this request? Yes No If yes, please provide details below (person/body/agency consulted; nature of discussion; comments received) The information and plans provided with this application may form part of an agenda as part of the reporting process. Page 3 Pre-lodgement Form 17A Advice Request State Development Assessment Unit Version: 1.2 (October 2020) Please provide the name and contact details of a team member who will be able to complete a Communications Summary for your development application. The summary should include information regarding communications and consultation activities related to your proposed development. * Information can be provided below or attached separately to this form. Name Contact details: Email: Phone: Address: Street Number/PO Box number, street name, suburb, state, postcode Town / suburb: Postcode: State: OFFICE USE ONLY Acceptance officer’s initials: Date received: SDAU pre-lodgement reference No.: The information and plans provided with this application may form part of an agenda as part of the reporting process. Page 4.
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