Form 5 - Change Application Form (3)

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)              G Patience c/- JDBA Certifiers
  Contact name (only applicable for companies)                     Richard Jones
  Postal address (P.O. Box or street address)                      PO Box 1365
  Suburb                                                           Mooloolaba
  State                                                            QLD
  Postcode                                                         4557
  Country                                                          Australia
  Email address (non-mandatory)                                    [email protected]
  Mobile number (non-mandatory)                                    1300 596 371
  Applicant’s reference number(s) (if applicable)                  BA240519

  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
                                        67                                     Gibson Road                           Noosaville
 a)                                     Lot No.                                Plan Type and Number (e.g.            Local Government
       Postcode
                                                                               RP, SP)                               Area(s)
       4563                             40                                     GTP100813                             Noosa Shire Council
       Unit No.                         Street No.                             Street Name and Type                  Suburb
 b)


[OCR of page images]
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) G Patience c/- JDBA Certifiers
Contact name (only applicable for companies) Richard Jones

Postal address (P.O. Box or street address) PO Box 1365

Suburb Mooloolaba

State QLD

Postcode 4557

Country Australia

Email address (non-mandatory) [email protected]

Mobile number (non-mandatory) 1300 596 371

Applicant's reference number(s) (if applicable) BA240519

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.
KX] Yes — the written consent of the owner(s) is attached to this change application
LC No

 

 

 

PART 2 —LOCATION DETAILS

XX] Street address AND lot on plan (a// lots must be listed), or

L 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
67 Gibson Road Noosaville

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

4563 40 GTP100813 Noosa Shire Council
Unit No. Street No. Street Name and Type Suburb

 

Queensland
Government