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Change application
Change application form Planning Act Form § (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 2076. 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 2076 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: Ail 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) ANORE US Maari nS Contact name (only applicable for companies) Postal address (P.O. Box or street address) Po Cox ws Suburb PEAT ASS G6EAce State QW Postcode 4093 Country Aust@auia Email address (non-mandatory) ard, € anbe’ \d . net =) Mobile number (non-mandatory) One P tS [kG Applicant's reference number(s) (if applicable) Is written con Planning Act 20 LO Yes — the written consent of the owner(s) is attached to this change application CINo PART 2 —- LOCATION DETAILS Street address AND lot on plan (ai fots must be fisted), Or CO 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 fisted). Unit No. | Street No. Zlob Postcode | Lot No. 87% 3 Unit No. | Street No. a) Postcode | Lot No. Street Name and Type Kn le w WAy Plan Type and Number (e.g. RP, SP) P_43 Street Name and Type Plan Type and Number (e.g. RP, SP) Suburb Per Local Government Area(s) COSa Sh We Suburb Ten oe Local Government Area(s) ? Queensland Government
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3.2) Coardinates of premise
| (Coordinates of premises by longitude and latitude
| Longitude(s) | Latitude(s) | Datum Local Government Area(s) (if applicable)
| Gwese4
| LJ GDAg4
| C Other: { _
(C1 Coordinates of premises by easting and northing
| Easting(s) Northing(s) | Zone Ref. | Datum _
a 054 ~T Alwesea
(1) Gpa94
other: [~
Local Government Area(s) (if applicable)
3.3) Additional premises
LJ Additional premises are relevant to the original development approvai and the detaiis of these premises have
erhot attached in a schedule to this application
N
|
[ lot required aa
PART 3— RESPONSIBLE ENTITY DETAILS
nsible entity that will be assessing this change application
W the Planning Act 201
Assessment
manager/approval entity
Development permit it Clean a
oO Preliminary approval JS 2006-2! i " Coa fri
LD Development permit
(1 Preliminary approval
Approval type
6) Type of change proposed
6:1) Provide a brief description of the chang aistolem Com iateae| bsTalme 9) 0]¢8) es
Oi Minor change application — proceed to Part 5
C Other change application — proceed to Part 6
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Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020
Page 3
PART 5 — MINOR CHANGE APPLICATION REQUIREMENTS Are there any affected entities for this change Ersoocitell No — proceed to Part 7 OO Yes -— list ail 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 pre- request response notice for the application has been request response provided) given, a copy of the notice must accompany this change application) OONo LC Yes — pre-request response is attached to this change application LI No C1 Yes — pre-request response is attached to this change application CINo D Yes - pre-request response Is attached to this change application PART 6 —- OTHER CHANGE APPLICATION REQUIREMENTS Note: To complete this part it will be necessary for you fo complete parts of DA Form 1 — Development application details and in some instances parts of DA Form 2 — Building work details, as mentioned below. These forms are available at hitps://planning.dsdmip.qid.gov.au Are there any additional premises included in this change application that were not part of the olen tcial ees] |W or level of assessment in this LA No LC Yes — the completed Sections 1 and 2 of Part 3 (Development details) of DA Form 1 — Development application details as these sections relate to the new or changed aspects of development are provided with this application res — the completed Part 5 (Building work details) of DA Form 2 — Building work details as it relates to the change application is provided with this application. pplication require referral for any referral requirements? teeter iniasel laclem ay TOMAR ale Lome eli letesiietat CJ Yes — the completed Part 5 (Referral details) of DA Form 7 — Development application details 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 under fthe DA Rules [4 agree to receive an information request if determined necessary for this change application (1 | 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 11) Information Page 3 Planning Act Form 5 - Change application form Version 1.2 — 7 February 2020
Page 4
« 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 requests is contained in the DA Forms Guide: Forms 1 and 2
| [4 Part 7 of DA Form 1 — Development application details is compieted as If the change application was a
development application and Is provided with this application.
PART 7 — CHECKLIST AND APPLICANT DECLARATION
13) Change application chec'
| have identified the:
« responsible entity in 4); and ,
e fora minor change, any affected entities; and Ves
e for an other change all relevant referral requirement(s) in 10)
Note: See the Planning Regulation 2017 for referral requirements
Fan
For an other change application, the relevant sections of DA Form 1 — Development Eves
application details have been completed and is attached to this application (Not applicable /
For an other change application, where building work is associated with the change ves
application, the relevant sections of DA Form 2 — Building work details have been
completed and is attached to this application
Supporting information addressing any applicable assessment benchmarks is attached to
CJ Not applicable
this application
Note: This includes any templates provided under 23.6 and 23.7 of DA Form 1 - Development application details ves
that are relevant as a resuit of the change application, a planning report and any technical reports required by the
relevant categorising instrument(s) (e.g the local government planning scheme, State Planning Policy, State
Development Assessment Provisions). For further information, see DA Forms Guide Planning report template
Relevant plans of the development are attached to this development application
Note: Relevant plans are required to be submitted for alt relevant aspects of this change application. For further
information, see DA Forms Guide Relevant plans.
14) Applicant declaration
ae making this change application, | declare that all information in this change application !s true and correct
Where an email address is provided in Part 1 of this form, | consent to receive future electronic communications
from the responsibie entity and any relevant affected entity or referral agency for the change application where
written information is required or permitted pursuant to sections 11 and 12 of the Electronic Transactions
Act 2001.
Note. it is unlawful to intentionally provide false or misleading information
Privacy — Personal information collected in this form will be used by the responsible entity and/or chosen
assessment manager, any relevant affected entity or referral agency and/or building certifier {including any
professional advisers which may be engaged by those entities) while processing, assessing and deciding the
change application.
Ail information relating to this change application may be available for inspection and purchase, and/or published on
the assessment manager's and/or referral agency's website.
Personal information will not be disclosed for a purpose unrelated to the Planning Act 2016, Planning Regulation 2017 |
and the DA Rules except where:
e such disclosure is in accordance with the provisions about public access to documents contained in the Planning
Act 2016 and the Planning Regulation 2017, and the access rules made under the Planning Act 2016 and
Planning Regulation 2017; or
e required by other legislation (including the Right to information Act 2009); or
e otherwise required by law.
This information may be stored in relevant databases. The information collected will be retained as required by the
i Public Records Act 2002.
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Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020
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PART 8 — FOR COMPLETION OF THE ASSESSMENT MANAGER -— FOR OFFICE USE ONLY Date received: [ Reference number(s): | QLeave notification and eae Note: For comple: VACA aL e Description of the work QLeave project number Amount paid ($) Date paid (dd/mm/yy) | Date receipted form sighted by assessment manager Name of officer who sighted the form Page 5 Planning Act Form 5 - Change application form Version 1.2 — 7 February 2020
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