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Change application form
Planning Act Form 5 (version 1.2 effective 7 February 2020) 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: All 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

 

1) Applicant details

 

 

 

 

 

 

 

 

 

Applicant name(s) (individual or company full name) KEVIN ALVSCIIA Y
Contact name (only applicable for companies)
| Postal address (P.O. Box or street address) oO. Box F7F2
| Suburb ZEW ANTTIV
| State QLD - 7
| Postcode AYS6 Ss
| Country Ats 7LALLA

 

| Email address (non-mandatory) CNS hare @& Big per: Conv

O/T LY FTO

 

Mobile number (non-mandatory)

| Applicant's reference number(s) (if applicable)

consent - Is written consent of the owner required his change application?

 

79(1A) of the Planning Act 2016 states the requirements in relation to owner's consent.

| (1 Yes - the written consent of the owner(s) is attached to this change application |
| No |

 

PART 2 — LOCATION DETAILS

3) Location of the premises (complete 3.1) or 3.2), and 3.3) as applicable)

 

3.1) Street address and lot on plan

(J Street address AND lot on plan (all Jots must be listed), Or

(J Street address AND lot on plan for an adjoining or adjacent property of the premises (appropriate for development in
| water but adjoining or adjacent to land e.g. jetty, pontoon. All lots must be listed). |

 

 

 

 

 

 

 

 

 

 

| Unit No. | StreetNo. | Street Name and Type Suburb , |

| a) / | WERIN STREET TEWAV TTIW
Postcode | Lot No. | Plan Type and Number (e.g. RP, SP) Local Government Area(s) |

| Ysts| / | KP 7Y607 Moe SH . |

[ | Unit No. | StreetNo. | Street Name and Type | Suburb

b) ;

| Postcode | Lot No. | Plan Type and Number (e.g. RP, SP) Local Government Area(s) |

 

 

 

  

Queensland
Government

  

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