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

 

 

4. Location of the premises

 

 

Unit No. Street No - 90 Street - Goodchap Street
Suburb - Noosaville ey ea stateoiln | Postcode 4566.
4 SP196846

§. Concurrence Agencies

 

Was there one or more concurrence agencies involved in the original approval? No

CO 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.

 

Concurrence achat : Date copy given

 
   

6. Pre-request response notice
Has a pre-request response ‘been given bya relevant entity (eg. a concurrence agency) for this request?

HNo Geo ; ; Eyes ee ii eek
If yes, please attach a copy of thenotice.

7. Owner’s consent

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

Table A — owner’s consent provided on form
Noosa Professional and Medical
Owner’sname/s Centre PtyLtd 0 The owner’s written consent is attached.

Owner’s name/s

IANVe, the above-mentioned owner/s of the land, consent |
to the making of this request.

 

Signature/s Zz

6 November 2014
Date

Table B — owner’s consent provided on form