Change to a DA (Caterers Shop to Retail Type 2 Shop & Salon - Hairdresser) - 51901.4863.07

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                                                                          Department of Infrastructure, Local Government and Planning



 5) Type of change proposed
 5.1) Provide a brief description of the changes proposed to the development appr val (e.g.changinga developmentepprovalfor a
 5 unit apartment building to provide for a 6 unit apartment building): -- P G ..(
   f:;-\-abl,slt\I\I1eJ\t-          eR- bl/dJ~'11'9                      alol\l'\ l,1 ~ +enltJ' +-) fIeMiS;:<2..i
     ~              u.sed      a; cateflll                       r         iora Q 'UZC].
  5.2) What type of change does this application propose.
  [B"Minor change application       - proceed to Pari 4
  o Other change application - proceed to Pari 5
PART 4 - MINOR CHANGE APPLICATION REQUIREMENTS


      No - proceed to Part 6
  DYes - list all affected entities below and proceed to Part 6
  Note: section 80(1) of the Planning Ac/ 2016 states that/he person making the change applica/ion must give notice of the proposal and
  the details olthe change /0 each affected entity as idenlified in sec/ion 80(2) of the Planning Act 2016.
  Affected entity                        Pre-request response provided? (where a pre-           Date notice given (where no pre-
                                         request response notice for the application has        request response provided)
                                         been given, a copy of the notice must
                                         accompany this change application)
                                          DNa
                                          DYes - pre-request response is allached to
                                          this change application
                                          ONo
                                          DYes - pre-request response is allached to
                                          this change application
                                          ONo
                                          DYes - pre-request response is attached to
                                          this change application


PART 5 - OTHER CHANGE APPLICATION REQUIREMENTS
Note: to complete this part it will be necessary for you to complete parts of DA Form 1 and in some instances parts of DA Form 2, as
mentioned below. These forms are available a/ www.dilqp.qld.gov.au.




    No
  DYes - complete Part 2 (Location details) of DA Form 1 as it relates to the additional premises is completed and
  provided with this application.




      No
   o Yes -the completed Part 5 (Building work details) of DA Form 2 as it relates to the change application is provided with
   this application.

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                                                                                               Planning Act Form 5 - Change application form
                                                                                                                   Version 1.0-3 July 2017

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                                                                                       Department of Infrastructure, Local Government and Planning




9) Referral details - Do any aspects of the change application require referral for any referral requirements?
Note me applicatlOlJ ml/;jl bp. It:!tmed 10 t:ClL:iJ feferral aqencv trlqqered by the chanqe appliC8fJOn as If the clMnge applicatiOn was tile angmal
development     application    IFlcludmg the proposed change

 lIli
 D Ves - the completed Sections 1 and 2 of Part 5 (Referral details) of DA Form 1 as it relates to the change application is
 provided with this application. Where referral is required for mailers relating to building work the referral checklist for
 building work is also completed.



        I agree to receive an information request if determined necessary for this change application
 D I do not agree to accept an information request for this change application
 Note: By not agreeing to accept an infonnation request I, the applicant, acknowledge:
 • that this change application will be assessed and decided based on the infonnation provided when making this change application
     and the assessment manager and any referral agencies relevant to the change application are not obligated under the DA Rules to
     accept any additional infonnation provided by the applicant for the change application unless agreed to by the relevant parties
 •      Part 3 of the DA Rules will still apply if the application is an application listed under section 11.3 of the DA Rules.
 Further advice about infonnation requests is contained in the DA Forms Guide.




 D Part 7 of DA Form 1 is completed as if the change application was a development application and is provided with this
 application.


PART 6 - CHECKLIST AND APPLICANT DECLARATION

 12) change application checklist
 I have identified the:
         •     responsible entity in 3); and
                                                                                                                      ciVes
         •     for a minor change, any affected entities; and

         •     for an 'other' change all relevant referral requirement(s)              in 9)
 Note: See the Planning Regulation 2017 for referral requirements
  For an 'other' change application, the relevant sections of DA Form 1 - Development                                 DVes
  detailshave been completed and is allached to this application                                                      C1Not applicable

  For an 'other' change application, where building work is associated with the change                                DVes
  application, the relevant sections of Form 2 - Building work details have been                                      B'Not     applicable
  completed and is allached to this application
  Supporting information addressing any applicable assessment benchmarks is attached
  to this application
  Note: This includes any templates provided under 23.6) of DA Fonn 1 that are relevant as a
  resull of the change application, a planning report and any technical reports required by the
                                                                                                                       DVes
  relevant categorising instrument(s) (e.g. the local govemment planning scheme, State Planning
  Policy, State Development Assessment Provisions). For further infonnation, see DA Fonns
  Guide: Planning report template.
  Relevant plans of the development are allached to this development application
  Note: Relevant plans are required to be submitted for all relevant aspects of this change                            DVes
  application. For further infonnation, see DA Fonns Guide: Relevant plans.




          y making this change application, I declare that all information in this change application is true and correct.
         Where an email address is provided in Part 1 of this form, I consent to receive future electronic communications                               from
     the responsible entity and any relevant affected entity or referral agency for the change application where wrillen
     information is required or permitted pursuant to sections 11 and 12 of the Electronic Transactions Act 2001.
     Note: /I is unlawful     to intentionally   provide false or misleading infonnation.

                                                                                                                                                        Page 3
                                                                                                              Planning Act Form 5 - Change application    form
                                                                                                                                     Version 1.0-3 July 2017

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                                                                            Department of Infrastructure. local Government and Planning


  Privacy - Personal information collected in this form will be used by the responsible entity andlor chosen assessment
  manager. any relevant affected entity or referral agency andlor building certifier (including any professional advisers which
  may be engaged by those entities) while processing, assessing and deciding the change application.
  All information relating to this change application may be available for inspection and purchase, andlor published on the
  assessment manager's andlor referral agency's website.
  Personal information will not be disclosed for a purpose unrelated to the Planning Act 2016, Planning Regulation 2017 and
  the DA Rules except where:
  • such disclosure is in accordance with the provisions about public access to documents contained in the Planning Act
       2016 and the Planning Regulation 2017. and the access rules made under the Planning Act 2016 and Planning
       Regulation 2017; or
  • required by other legislation (including the Righi to Information Act 2009); or
  • otherwise required by law.
  This information may be stored in relevant databases. The information collected will be retained as required by the Public
  Records Act 2002.


PART 7 - FOR OFFICE USE ONLY

  Date received:       ________                  1   Reference number(s):



  QLeave notification and payment
  Note For compfeflOn by assessment manager If applicable

  Description of the work
  QLeave project number
  Amounl paid ($)
  Date paid
  Date receipted form sighted by assessment manager
  Name of officer who sighted the form

The Planning Acl 2016. the Planning Regulation 2017 and the DA Rules are administered by the Department of
Infrastructure. Local Government and Planning. This form and all other required change application materials should be
sent to the responsible entity.




                                                                                                                                     Page 4
                                                                                              Planning Act Form 5 - Change application fonn
                                                                                                                   Version 1.o-J July 2017

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To Noosa Council,

Re change application   form.

John and Alison McDermott       are the owners of Lot 30, 18 Hastings St, Bay Village on Hastings, Noosa
Heads.

In accordance with the Change of Application     form, Part 1, we hereby consent to the changes being
applied for by our prospective tenant (the applicant in this case).

Should you require any further information     or detail please do not hesitate to contact us.

John McDermott

john m cde [email protected]

042179269S