Change to Building Envelope - 152004.240041.4

PART 6- OTHER CHANGE APPLICATION REQUIREMENTS
Note: to complete this part it will be necessary for you to complete parts of DA Form 1 and in some instances parts of DA Form
2, as mentioned below. These forms are available at https://planning.dsdrinip.q1d.gov.au

8) Location details - Are there any additional premises included in this change application that were not part of the
original development approval?
lEa No
▪ Yes — complete Part 2 (Location details) of DA Form 1 as it relates to the additional premises is completed and
 •rovided with this a• •lication.

9) Development details
9.1) Is there any change to the type of development, approval type, or level of assessment in this change application?
RA No — proceed to 11)
Al Yes — the completed Sections 1 and 2 of Part 3 (Development details) of DA Form 1 as these sections relate to
the new or chan ed as• ects of develo•ment are rovided
                                                 •        with this a• slication.
9.2) Does the change application involve building work?
• No
IEI Yes — the completed Part 5 (Building work details) of DA Form 2 as it relates to the change application is provided
with this application.

10) Referral details — Does the change application require referral for any referral requirements?
Note: The application must be referred to each referral agency triggered by the change application as if the change application was the original
development application including the proposed change.
E No
Lii Yes — the completed Part 5 (Referral details) of DA Form 1 as it relates to the change application is provided with
this application. Where referral is required for matters relating to building work the Referral checklist for building work
is also completed.

11) Information request under Part 3 of the DA Rules
E I agree to receive an information request if determined necessary for this change application
• I do not agree to accept an information request for this change application
Note: By not agreeing to accept an information request I, the applicant, acknowledge:
that this change application will be assessed and decided based on the information provided when making this change application
and the assessment manager and any referral agencies relevant to the change application are not obligated under the DA Rules to
accept any additional information provided by the applicant for the change application unless agreed to by the relevant parties
Part 3 of the DA Rules will still apply if the application is an application listed under section 11.3 of the DA Rules.
Further advice about information re uests is contained in the DA Forms Guide: Forms 1 and 2.

12) Further details
E Part 7 of DA Form 1 is completed as if the change application was a development application and is provided with
this application.

PART 7- CHECKLIST AND APPLICANT DECLARATION
13 chan.e a..lication checklist
I have identified the:
responsible entity in 4); and
for a minor change, any affected entities; and                                                               LA Yes
for an 'other' change all relevant referral requirement(s) in 10)
Note: See the Planning Regulation 2017 for referral requirements
For an 'other' change application, the relevant sections of DA Form 1 —
Development application details have been completed and is attached to this                                  LII Yes
                                                                                                             M'Not applicable
application
For an 'other' change application, where building work is associated with the
                                                                                                             ['Yes
change application, the relevant sections of DA Form 2 — Building work details
have been completed and is attached to this application                                                      LI Not applicable
Supporting information addressing any applicable assessment benchmarks is
                                                                                                             V'Yes
attached to this application


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