09/1654 - Preliminary Building Works Assessable Against the Planning Scheme [As Published] · 172009.1654

6 Ot . RECEIVED

at : . 19 NOV 2009

PartA, Version 3.4,

 

Common details
;NOTE: Answer all questions unless direcied to go toa Particular question. Refer to the end of the form for advice on how to complete this form...

fees Ra ener ie

 
 
 
 

 

seehication

ee

 

| ompanyiorgenisaton name (if applicable) [Platnum Pr

Individual applicant/Contact Person (If there is more than one applicant, provide additional applicant details on an attachment fo this form)

Title Ina i Lastname —|Stopka :

Postal address.

 

 

  

 

 

 

 

 

 

Contact telephone number {07 4127 13: | Mobile phone number : 0421 476 333 i

 

 

 

 

 

Facsimite number , 07 4128 1133 : e-mail address

 
  

 

 

 

    
     

Rose:

1. Identify the premises by completing Table A, or Table B and/or TableC {ensure adequate information is given to identity the premises)
Table A _ {Ifthe application is for a mobile and temporary Environmentally Relevant Activity (ERA), complete Table A only. Then go to Q2.

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OR
Table B Street address for the premises (lick applicabie boxes below and insert property description in the fab}

  

 

   
 

 

 

 

 

 

ie. ideniify each lot in a separate row. }
{i) Street address / jot on plan for the Premises (Appropriate for most applications including building applications): or

(ii) O Street address /ot on plan for the land adjoining or adjacent to the premises (Appropriate for development in water e.g, jetty,
ponteon etc) (Note: Loton plan details may be obtained from titfe documents, a ‘Rate’ notice. or from the local government.)

‘pti aE

    

 

  

 

    
 

 

 

[4
AND/OR

Table C Coordinates and/or a map of the premises (Appropriate for development in remole areas,
Bay} etc.}

 

 

 

 

 

 

 

 

Noosa - Sunshine Coast _

 

over part of a fot, in water (e.g. channel dredging in Moreton

 

 

 

 

 

 

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T~ pepage

   

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[~: Other -

 

 

 

 

 

 

 

 

 

2.

identify if any of the following apply to the premises by completing Tables D, E” or F. (Note: im most instances, the premises wil Not involve any of
the following characteristics, however some applications may involve one or more of these characteristics - complete only if applicable)