DA 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)                G & A Duley & A & A Bell - Natani Design Pty Ltd C/- Suncoast
                                                                    Building Approvals
 Contact name (only applicable for companies)                       Richard Holden
 Postal address (P.O. Box or street address)                        PO Box 1054
 Suburb                                                             MAROOCHYDORE
 State                                                              QLD
 Postcode                                                           4558
 Country                                                            Australia
 Contact number                                                     07 5443 7288
 Email address (non-mandatory)                                      [email protected]
 Mobile number (non-mandatory)
 Fax number (non-mandatory)
 Applicant’s reference number(s) (if applicable)                    VA Ref # 12679 & 11981

 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
  ☐      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
  ☒      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).

 a)      Unit No.                 Street No.                  Street Name and Type                      Suburb
         8 & 11                   37                          Hastings Street                           NOOSA HEADS
         Postcode                 Lot No.                     Plan Type and Number (e.g. RP, SP)        Local Government Area(s)
         4567                     8 & 11                      BUP 8083                                  Noosa Council
 b)      Unit No.                 Street No.                  Street Name and Type                      Suburb


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




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