NC Permissible change form Signed · 132004.240098

4. Location of the ideas

Unit No. 3 | Street No- _ 229-231 Street _ Gympie Terrace

    

‘Suburb | Noosaville. _ ; ‘State aid 7 "Postcode 4567 7
EBay ew elem ee
083s 188227

 

   

5. Concurrence Agencies

_ Was there one or more concurrence agencies involved in the original approval?

 

 
     
 
 
 
    
   
 
 

ee ad Sasa details b below

“Note — - Under 372 of the Sustainable Planning Act 2009 the person m making the request is required to give a copy of this request to all |
| concurrence agencies.

Concurrence Agency Date copy given

 

     

 

{

| Has a pre-request respon

No

   

CeO eels

iIs the owner's consent required for this request? ‘ONo

id Yes- es— complete either Table A or ‘Table Bbelow =
| Note — If more than one owner of ‘the land all. ‘owners’ details are 2 required |

 

Table B — owner's consent provided on form

| Owner’ 's name/s

  

Table A — owner's consent provided on dat
NoasA AGM TREE doconuas Ye
lait - “the 233 Gumhe Tce Abpsnville THUS a

mene above-mentioned owner/s of the land, consent a The owner's written consent is attached.
to the making of this request. oe — OO

 

| Owner s name/s

 

 

  

| Signature/s

| Date

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