PlanningActForm5-Changeapplicationform (2)

                                                  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 – complete Part 2 (Location details) of DA Form 1 as it relates to the additional premises is completed and
provided with this application.

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 – proceed to 11)
   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.

11) Information request under Part 3 of the DA Rules
   I agree to receive an information request if determined necessary for this change application
   I 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:
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.

12) Further details
    Part 7 of DA Form 1 is completed as if the change application was a development application and is provided with
this application.

PART 7 – CHECKLIST AND APPLICANT DECLARATION
13) change application checklist
I have identified the:
                                                                                                                Yes
responsible entity in 4); and
                                                                                                             X Not applicable
for a minor change, any affected entities; and


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                                                                                                  Planning Act Form 5 - Change application form
                                                                                                                  Version 1.1 — 22 JUNE 2018