Img_20231006_0003

Change application form
Planning Act Fom 5 (version 1.2 effective 7 February 2020)                              under Section 282 of the Planning Act 2016.

This form is to be used for a change application made under          78 ol the Planning Act 2016. lt is importantwhen
making a change application to be aware of whether the application ts fora minor change that willbe assessed under
section 81 of tha P/anring Act 2016 ot fot an other change that will  assessed under section 82 of rhe Planhing Act
2016.
An applicant must complete allparts of this form, and provide any s                        ng information that the form identifies as
being requhed to accompany the change apptication, unless stated                         rwise. Additional pages may be attached if
there is insufficient space on the form to complete any part.
Not : All tems us-.tl in this t'arn have the heaning givcn unde. the Planning Act 20   the Planning Regulation 2A17, orlhe Oeveiapnent
Assessment Rules      lD Rules).



PART 1 _APPLICANT DETAILS
                                                                                                                      { t@ul
  1) Applcant deta ls
  Applicant name(s) (lrdMil,a/ or conpany tut name)                , , il.li   .


  Conlact nafie (@ly appljcabte br conpanies)                       6er.l -l+ 1d&1'{O
  Postal address fPo. Box ot steet address)                        s8 6R.-( ?J\|fr1 @)Ve
  Suburb                                                           Noc\.\ft vtwL
  State
  Postcode                                                          u,Shq,
  Country                                                          fN^lTrl tUR
  Email address fnon-rrardalory)                                   €rtaLakor .avdv\\[email protected]\
  I\robile number fron,rardatory)                                   ou-r<-1i il q,{!f-
  Applicant's reference number(s) (,il apprbable)

  2) Owner's consent - ls written consent of the owner required for this change application?
  Note. Sectah 7911A) of the Ptannng Act 2a16 states the requrcnents in rclatian la a||nefs cansent

  E Yes -the written consent ofthe owne(s) is attached to thls                         nge applicatior
  ENo

PART 2 _ LOCATION DETAILS
   3) Location of the premlses lco,,p/--ae 3 1) ori 2). ant13.3) as appticabte)
   3.1) Streei address and lot on plan

   n Street address AND lot on plan {a/ /ors m./st ,e ,ved), or
   I Street address AND    lot on plan for an adjoining or adjacent pr )perty of the premises ppbpiate ror devetopnent in
                    ot adjacent to tand   jev pontoon- AI tots must be tist
                                                                                                                (a

          water but adjcrning                 e.g-

               Unit No          St@et No     Street Name and Type                                      Suburb

     a)
                                Jss         5+lqlaloelve                                              N00lhL4L!€,
               Postcode         Lot No.       Plan Type and Number fe.g. Rf sP)                        Local Government Area(s)
                          rq-       sp2rbo-]q                                                         r.l6USft
               U,it N" Tstr-"i N" l Street Name and Type                                               Suburb

     b)
               Postcode         Lot No        Plan Type and Number fe.g. RI sP)                        Local Government Area(s)




                                                                                                         w             Queensland
                                                                                                                       Government