Appendix A - Form 5

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


This form is to be used for a change application made under section 78 of the Planning Act 2016. It is important when
making a change application to be aware of whether the application is for a minor change that will be assessed under
section 81 of the Planning Act 2016 or for an other change that will be assessed under section 82 of the Planning Act
2016.
An applicant must complete all parts of this form, and provide any supporting information that the form identifies as
being required to accompany the change application, unless stated otherwise. Additional pages may be attached if
there 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

  1) Applicant details
  Applicant name(s) (individual or company full name)                     Sunshine Butterflies Inc.
  Contact name (only applicable for companies)                            Neil de Bruyn
  Postal address (P.O. Box or street address)                             c/o Access Town Planning Consultants, PO Box 4381
  Suburb                                                                  Springfield Central
  State                                                                   Qld
  Postcode                                                                4300
  Country                                                                 Australia
  Email address (non-mandatory)                                           [email protected]
  Mobile number (non-mandatory)                                           0438 525 967
  Applicant's reference number(s) (if applicable)                         23.001

  2) Owner’s consent - Is 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
  KI No

PART 2 - LOCATION DETAILS

  3) Location of the premises (complete 3.1) or 3.2), and 3.3) as applicable)
  3.1) Street address and lot on plan
  K Street address AND lot on plan (all lots must be listed), or
  □ 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                                     Suburb
                              468                McKinnon Drive                                           Cooroibah
    a)
              Postcode        Lot No.            Plan Type and Number (e.g. RP, SP)                       Local Government Area(s)
              4565            2                  RP214534                                                 Noosa Shire Council
              Unit No.        Street No.         Street Name and Type                                     Suburb

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




                                                                                                                      Queensland
                                                                                                                      Government