Signed Changes Form · 132004.240098

sN

 
 

RS of request (please tick ALL applicable Sala

BY To change the development io To change the development 'O To extend the relevant period
approval i conditions ! before lapsing

Please attach documentation outlining the detail of and the reasons and justification for the requested change or
extension. . , . |

    

4. Location of the premises

 

UnitNo. 3 [Street No 229-231 | Street Gympie Terrace .
Suburb Noosaville ; State Qld | Postcode 4566
Lot no. Plan type & pian no.

lot 0. and lot 3 SP188227

 

 

 

 

 

 

 
  
 

5. Concurrence Agencies
Was there one or more concurrence agencies involved in the original approval?

   

|C 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 fo all
concurrence agencies.

 

Concurrence Agency Date copy given

 

 

&

Has a pre-request response been given by a relevant entity (eg. a concurrence agency) for this request?
Nw No | O Yes
If yes, please attach a copy of the notice.

 

 

 

ei ater ee .
ls the owner's consent required for this request? 'O.No

 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

   

Table B — owner’s consent provided on form

 

 

 

:

Owner's name/s Lop Gp Lek | Owner's name/s Pt
Noasy fac TREE Hocaines HL |

(We, the above-mentioned owner/s of the land, consent | O The owner's written consent is attached.

 

 

to the making of this request, ., , /

HAAZA =<

 

 

Signature/s

 

 

 

 

Date (AA SIE

 

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