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3. Nature of request (please tick ALL applicable categories)

O To change the development MO Tochange the development IW To extend the relevant period
approval conditions before lapsing

Please attach documentation outlining the detail of and the reasons and justification for the requested change or
extension.

4. Location of the premises

Unit No. Street No 2s Street Granp STREES .
Suburb NOOSA HEABS State Ate,
lor 7. SP '17987%

 

Postcode ¢+C67.

  
   

   
  

 
  
 

 
 

    

5. Concurrence Agencies

Was there one or more concurrence agencies involved in the original approval? Ko
0 Yes-provide details below

Note — Under s372 of the Sustainable Planning Act 2009 the person making the request is required to give a copy of this request to all
concurrence agencies.

   

Eco

 

6. Pre-request response notice

Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?

io O Yes

If yes, please attach a copy of the notice.

7. Owner’s consent

Is the owner’s consent required for this request? O No
eVes— complete either Table A or Table B below
Note — If more than one owner of the land all owners’ details are required

   

Bee eae cece

 

Ace
Benner Anew peers &

ia
ASSOMMASES TU. LAB,

We, the above-mentioned owner/s of the land, consent (1) The owner’s written consent is attached.
to the making of this request.

 

Owner's name/s Owner's name/s

Signature/s
Paria Beare g

Date Z2ke. Poa, ZLols.

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