Signed Form · MCU14/0016.01

Eee of request (please tick ALL applicable categories) a

To change the development O_ To change the development O To extend the relevant period
approval conditions before lapsing

       

Please attach documentation outlining the detail of and the reasons and justification for the requested change or
extension.

4. Location of the premises

Unit No. Street No 24 Street Lanyana Way

Suburb Noosa Heads State Qld Postcode 4567
1 RP129285 |
2: RP129285.

5. Concurrence Agencies

Was there one or more concurrence agencies involved in the original approval? No

O Yes-provide details below

Note — Under s372 of the Sustainable Planning Act 2009 the person making the request is required to give a copy of this request to all
concurrence agencies.

Concurrence Agency | Date copy given

6. Pre-request response notice

Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?
No O Yes

If yes, please attach a copy of the notice.

7. Owner’s consent

Is the owner’s consent required for this request? O No
Yes— complete either Table A or Table B below

Note — If more than one owner of the land all owners’ details are required

Table A — owner's consent provided on form Table B — owner's consent provided on form

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Owner's name/s Owner's name/s

We, the above-mentioned owner/s of the land, consent O The owner's written consent is attached.
to the making of this Se e.,
_ Signature/s Lee oes Pte
C DAZ ra)
Date 18 fos [vos