Form

 5) Type of change proposed
 5.1) Provide a brief description of the changes proposed to the development approval (e.g. changing a development approval for a
 5 unit apartment building to provide for a 6 unit apartment building):
 Refer to attached correspondence.
 5.2) What type of change does this application propose?
     Minor change application – proceed to Part 4
     Other change application – proceed to Part 5

PART 4 – MINOR CHANGE APPLICATION REQUIREMENTS
 6) Are there any affected entities for this change application
     No – proceed to Part 6
     Yes – list all affected entities below and proceed to Part 6
 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 pre-
                                             request response notice for the application has                request response provided)
                                             been given, a copy of the notice must
                                             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 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 at www.dilgp.qld.gov.au.


 7) 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.

 8) Development details
 8.1) Are there any new or changed development aspects included in this change application that are not part of the
 original development approval?
   No – proceed to 9)
   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.
 8.2) 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.

 9) Referral details - Do any aspects of 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
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                                                                                                           Planning Act Form 5 - Change application form
                                                                                                                                Version 1.0—3 July 2017