Planning Act Form 5 (002)

Change application form

Planning Act Form 5 (version 1.1 effective 22 JUNE 2018) made under Section 282 of the Planning Act 2016.
This form is to be used for a change application made under section 78 of the Planning Act 2016. It is important
when making a change application to be aware of whether the application is for a minor change that will be
assessed under section 81 of the Planning Act 2016 or for an ‘other’ change that will be assessed under section 82
of the Planning Act 2016.

An applicant must complete all parts of this form, and provide any supporting information that the form identifies as
being required to accompany the change application, unless stated otherwise. Additional pages may be attached if

there is insufficient space on the form to complete any part.
Note: Ail terms used in this form have the meaning given under the Planning Act 2016, the Planning Regulation 2017, or the
Development Assessment Rules (DA Rules).

PART 1 — APPLICANT DETAILS

Applicant name(s) (individual or com full name Stockwell Development Grou
Contact name (only applicable for companies) Harry Hurst — Development Assistant

Postal address (P.O. Box or street address) PO Box 3144
Suburb South Brisbane
State Queensland
Postcode 4101

Coun Australia

Email address [email protected]
Mobile number (non-m 0478 792 447
Applicant's reference number(s

2), Owner's consent ~ Is written consent of the owner required for this change application?
Note: section 79(1A) of the Planning Act 2016 siates the requirements in relation to owner's.consent.
Yes — the written consent of the owner(s) is attached to this change application
No

 

 

PART 2 — LOCATION DETAILS

Street address AND lot on plan (ail /ots must be listed), or

(_] Street address AND lot on plan for an adjoining or adjacent property of the premises (appropriate for development in
water but or t to land e.g. toon, all lots must be list

Unit No. Street No. Street Name and T Suburb
28A Eenie Creek Road Noosaville

Postcode Lot No. Plan T and Number (e.g. Local Government Area(s
3 SP246584 Noosa Shire Council

Unit No. Street No. Street Name and T Suburb

a)

Postcode Lot No. Plan Type and Number (e.g. Local Government Area(s

Coordinates of premises by longitude and latitude
Longitude(s Latitude(s Datum Local Government Area(s) (if
WGS84
CL] GDA94
Other:

 

Coordinates of premises by easting and northi

  

Ely
ey Queensland
Age Government

Sto