DA Form 5 Change application form

PART 5 – MINOR CHANGE APPLICATION REQUIREMENTS
7) Are there any affected entities for this change application
 No – proceed to Part 7
☐ Yes – list all affected entities below and proceed to Part 7
Note: section 80(1) of the Planning Act 2016 states that the person making the change application must give notice of the proposal
and the details of the change to each affected entity as identified in section 80(2) of the Planning Act 2016.
Affected entity                               Pre-request response provided? (where a pre-                   Date notice given (where no
                                              request response notice for the application has                pre-request response
                                              been given, a copy of the notice must                          provided)
                                              accompany this change application)
                                              ☐ No
                                              ☐ Yes – pre-request response is attached to
                                              this change application
                                              ☐ No
                                              ☐ Yes – pre-request response is attached to
                                              this change application
                                              ☐ No
                                              ☐ Yes – pre-request response is attached to
                                              this change application

PART 6 – 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 at https://planning.dsdmip.qld.gov.au

8) Location details - Are there any additional premises included in this change application that were not part of the
original development approval?
 No
☐ Yes – complete Part 2 (Location details) of DA Form 1 as it relates to the additional premises is completed and
provided with this application.

9) Development details
9.1) Is there any change to the type of development, approval type, or level of assessment in this change application?
 No – proceed to 11)
☐ Yes – the completed Sections 1 and 2 of Part 3 (Development details) of DA Form 1 as these sections relate to
the new or changed aspects of development are provided with this application.
9.2) Does the change application involve building work?
☐ No
☐ Yes – the completed Part 5 (Building work details) of DA Form 2 as it relates to the change application is
provided with this application.

10) Referral details – Does the change application require referral for any referral requirements?
Note: The application must be referred to each referral agency triggered by the change application as if the change application was the original
development application including the proposed change.

☐ No
☐ Yes – the completed 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 matters relating to building work the Referral checklist for building work
is also completed.
11) Information request under Part 3 of the DA Rules
 I agree to receive an information request if determined necessary for this change application

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                                                                                                  Planning Act Form 5 - Change application form
                                                                                                                  Version 1.1 — 22 JUNE 2018