Appendix A - Form 5 OPW16_0303

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)                  Palm Lake Works Pty Ltd
  Contact name (only applicable for companies)                         Amy Clements
  Postal address (P.O. Box or street address)                          PO Box 10479
  Suburb                                                               Southport
  State                                                                QLD
  Postcode                                                             4215
  Country                                                              Australia
  Email address (non-mandatory)                                        [email protected]
  Mobile number (non-mandatory)
  Applicant’s reference number(s) (if applicable)

  2) Owner’s consent - Is written consent of the owner required for this change application?
  Note: Section 79(1A) of the Planning Act 2016 states the requirements in relation to owner’s consent.

      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
      Street address AND lot on plan (all lots must be listed), or
      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.        Street No.         Street Name and Type                                    Suburb
                           19                 Trading Post Road                                       Cooroy
    a)
           Postcode        Lot No.            Plan Type and Number (e.g. RP, SP)                      Local Government Area(s)
                           102                SP287641                                                Noosa Shire Council
           Unit No.        Street No.         Street Name and Type                                    Suburb

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