Change application form

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

 

ps form is to be used for a change application made under section 78 of the Planning Act 2016. It is important when
si ‘aking a change application to be aware of whether the application is for a minor change that will be assessed under
at 81 of the Planning Act 2016 or for an other change that will be assessed under section 82 of the Planning Act

An applicant must complete all parts of this form, and provide any supporting information that the form identifies as
th ing required to accompany the change application, unless stated otherwise. Additional pages may be attached if
ere is insufficient space on the form to complete any part.

Note: All terms used in this form have the meaning given under the Planning Act 2016, the Planning Regulation 2017, or the Development
Assessment Rules (DA Rules).

PART 1 — APPLICANT DETAILS

Applicant name(s) (individual or company full name)
Contact name (only applicable for companies)
Postal address (P.0. Box or street address)
Suburb

State

Postcode

Country

Email address (non-mandatory)

Mobile number (non-mandatory)

Applicant's reference number(s) (if applicable)

2) Owner's consent - {s written consent of the owner required for this change application?
Note: Section 79(1A) of the Planning Act 2016 states the requirements in relation to owner's consent.

 

(Yes ~ the written consent of the owner(s) is attached to this change application
| S4No
PART 2 —LOCATION DETAILS

 

     
 

address AND lot on plan (al! Jots must be listed), OF

CD Street address AND lot on plan for an adjoining or adjacent property of the premises (appropriate for development in
water but adjoining or adjacent to land e.g. jetty, pontoon. All lots must be listed).

Unit No. | Street No. | Street Name and Type
eE\
Plan Type and Number (e.g. RP, SP)

 
  

    

     
   
  

Suburb

      
 

     
    

   

Ne

Local Government Area(s)

 
  
    

    

   

 
  

a)

Postcode | Lot No.

  
    

        

  

Suburb!

 

Unit No. | StreetNo. | Street Name and Type

   
 

   
 
 
 

   

Postcode | Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)

  

Queensland
Government