23120 DA Development Application part 1 of 2 Application Letter and Request to Change form 132002.220611.3

Application no.     Amount paid         Date paid          Receipt no.          Initial            Date stamp


Receiving Officer




Payment options
In person      Customer service centres: 8.30 am to 4.30 pm Monday to Friday (excludes public holidays).
By mail        Cheque or money order to be made payable to: Sunshine Coast Regional Council.
               q Cheque                    q Money order                 q Mastercard               q Visa
               Card number                                               Expiry date                Amount $
               Name on card                                              Signature of cardholder
               Phone                                                     Is a receipt required?       q Yes         q No
4 of 4    2011/12 Regional Strategy and Planning Request to Change Existing Approval and/or Extension to Relevant Period FM4U1