Change to Building Envelope - 152004.240041.4

Fasting(s)              Northings)             Zone Ref.            Datum                Local Government Area(s) (if applicable)
                                               L54                  El WGS84
                                               El 55                   GDA94
                                               L56                  El Other:
3.3) Additional premises
El Additional premises relevant to the original development approval and their details have been attached in a
schedule to this application
El Not required

PART 3- RESPONSIBLE ENTITY DETAILS
4) Identify the responsible entity that will be assessing this change application
Note: see section 78 3 of the Plannin • Act 2016



PART 4- CHANGE DETAILS
5) Provide details of the existing development approval subject to this change application
Approval type                      Reference number              Date issued                                Assessment
                                                                                                            manager/approval
                                                                                                            entity
II Development permit
ai  Preliminary approval                        \ .S)- )c• k+ ' .2o'-i-)
El Development permit
El Preliminary approval
6) Type of change proposed
6.1) Provide a brief description of the changes proposed to the development approval (e.g. changing a development approval
for a five unit apartment building to provide for a six unit apartment building):

              rt3 412A            0,0t'S ae...                S'N n         loo'

6.2) What type of change does this application propose?
El Minor change application — proceed to Part 5
El Other change application — proceed to Part 6

PART 5- MINOR CHANGE APPLICATION REQUIREMENTS
7) Are there any affected entities for this change application
n No — proceed to Part 7
El Yes — list all affected entities below and proceed to Part 7
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
                                          request response notice for the application has pre-request response
                                          been given, a copy of the notice must                     provided)
                                          accompany this change application)
                                                     No
                                                El Yes — pre-request response is attached to
                                                this change application
                                                    No
                                                El Yes — pre-request response is attached to
                                                this change application
                                                El No
                                                El Yes — pre-request response is attached to
                                                this change application



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                                                                                        Planning Act Form 5 - Change application form
                                                                                                        Version 1.1 —22 JUNE 2018