Pre-Request Response application 132008.176.02

ee . | Concurrence Agency — please specify:

     
 

3. Nature of proposed change/s (please tick ALL applicable categories)
To change the development approval issued by:
Planning & Environment Court

To change the conditions issued by;
Planning & Environment Court

{1 Minister I Council (as a Concurrence agency)

O Other entity — please specify: iC) Minister

QO Other entity — please specify:
Please attach documentation outlining the detail of and the reasons and justification for the requested change/s._

  

4, Location of the premises
StreetNo | [Street SECRET

| Suburb ‘Nooser HEAPS “|Postcode Nb]

   

5. Declaration of applicant

We, the applicant, declare that the above information is correct in all respects, at the time of lodgement of this
application with the Sunshine Coast Regional Council. Should any of the details given in relation to this application be
changed in the future, the applicant shall advise the Sunshine Coast Regional Council in writing prior to any such change
being implemented.

Signature

 

 

Application no. | Amount paid Date paid Receipt no. Initial Date stamp

| Receiving Officer

 

 

 

 

Payment options
iIn person | Customer service centres: 8.30 am to 4. 30 pm Monday to Friday (excludes public holidays). :

: By mail | Cheque or money order to be made payable to: Sunshine Coast Regional Council.
: iO] Cheque i ia Money order ' a Mastercard DVisa
‘Card number | Expiry date Amount $

: Name on card
Phone

ignature of cardholder ;
Is a receipt required? OYes ONo

  

2o0f2 2012/13 Regional Strategy and Planning Pre-Request Response Application FM3001/2-22/06/2012