Form 5 - Change 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
     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.
 9.2) Does the change application involve building work?
    No
    Yes – 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.

 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 – 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.

 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 – Development application details 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:
  responsible entity in 4); and
  for a minor change, any affected entities; and                                                                         Yes
  for an other change all relevant referral requirement(s) in 10)
 Note: See the Planning Regulation 2017 for referral requirements
 For an other change application, the relevant sections of DA Form 1 – Development                                        Yes
 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                                       Yes
 application, the relevant sections of DA Form 2 – Building work details have been
 completed and is attached to this application                                                                            Not applicable

 Supporting information addressing any applicable assessment benchmarks is attached to
 this application
 Note: This includes any templates provided under 23.6 and 23.7 of DA Form 1 – Development application details            Yes
 that are relevant as a result 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                                           Yes


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