Request to Change Existing Approval and-or Extension to Relevant Period - Signed

Request to Change Existing Approval and/or Extension to
e See eeoonern rele Pad
2014/15

Sustainable Planning Act 2009

This form must be submitted to Council accompanied by the applicable fee.
Attach extra pages if there is insufficient space on the form.
Please note that for development approvals that include water and sewerage conditions, a Unitywater fee may also apply.

1. Details of person making the request

Full name — Noosa Professional and Medcail Centre Pty Ltd
Contact Name — Shane Adamson c/- Adamson Town Planning Pty Ltd
Postal address - PO Box 1613

Suburb - Noosaville State - QLD Postcode - 4566
Business phone — 07 5430 6671 A/H phone Mobile 0437 754 420
Email address — [email protected] Fax — 07 5430 6677

2. Details of existing approval

Type of approval (please tick ALL applicable categories) Which entity issued approval?
Development Permit M Council

Preliminary Approval Ol Other entity — please specify
Compliance Permit

Material Change of Use

Reconfiguring a Lot

Operational Works

Building Works

Plumbing or Drainage Works

Compliance Certificate

Environmentally Relevant Activity

Application number/council reference — 132007.12.4 (07/0012) Date issued - 24 February
2011

Is the approval for a mobile and temporary ERA? M No O Yes -— complete below
Insert the name of each local government area in which the mobile and temporary ERA is proposed to operate/operating

OOOODOOSBBROOCBW

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

M Tochange the development M Tochange the development O 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.

Privacy

Council will use any personal information provided for the intended purpose only and for remaining in contact with you. Council is authorised to collect
this information in accordance with the Local Government Act 2009 and other Local Government Acts. Your personal information is only accessed by
persons authorised to do so. Your personal information is dealt with in accordance with council's privacy policy.

www.noosa.qid.gov.au [email protected] T 07 5329 6500
PO Box 141 Tewantin Qld 4565 ABN 97 969 214 121

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