DA Form 5

PART 5 – MINOR CHANGE APPLICATION REQUIREMENTS
 7)    Are there any affected entities for this change application
  ☒    No – proceed to Part 7
  ☐    Yes – list all 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                    Date notice given (where no
                                                    pre-request response notice for the                        pre-request response
                                                    application has been given, a copy of the                  provided)
                                                    notice must accompany this change
                                                    application)
                                                     ☐      No
                                                     ☐      Yes – pre-request response is
                                                            attached to this change application
                                                     ☐      No
                                                     ☐      Yes – pre-request response is
                                                            attached to this change application
                                                     ☐      No
                                                     ☐      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 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.dsdmip.qld.gov.au

 8)    Location details - Are there any additional premises included in this change application that were not part of the
       original development approval?
  ☒    No
  ☐    Yes

 9)    Development details
 9.1) Is there any change to the type of development, approval type, or level of assessment in this change application?
  ☒    No
  ☐    Yes – the completed Sections 1 and 2 of Part 3 (Development details) of DA Form 1 as these sections relate to
       the new or changed aspects of development are provided with this application.
 9.2) Does the change application involve building work?
  ☒    No
  ☐    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.

  ☒    No
  ☐    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.




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                                                                                                Planning Act Form 5 - Change application form
                                                                                                               Version 1.2 — 7 February 2020