Attachment A - DA Form 5.pdf

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)                  Noosa Domain Pty Ltd C/- JFP Urban Consultants Pty Ltd
  Contact name (only applicable for companies)                         Timothy Balcombe
  Postal address (P.O. Box or street address)                          T209 Tower 1 Kon Tiki Business Centre, 55 Plaza Parade
  Suburb                                                               Maroochydore
  State                                                                QLD
  Postcode                                                             2558
  Country                                                              Australia
  Email address (non-mandatory)                                        [email protected]
  Mobile number (non-mandatory)
  Applicant’s reference number(s) (if applicable)                      M1717P

  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).
           Unit No.        Street No.         Street Name and Type                                    Suburb
                           35                 Walter Hay Dr                                           Noosaville
    a)
           Postcode        Lot No.            Plan Type and Number (e.g. RP, SP)                      Local Government Area(s)
                           2                  SP162077                                                Noosa Council
           Unit No.        Street No.         Street Name and Type                                    Suburb

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


[OCR of page images]
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) Noosa Domain Pty Ltd C/- JFP Urban Consultants Pty Ltd
Contact name (only applicable for companies) Timothy Balcombe

Postal address (P.O. Box or street address) T209 Tower 1 Kon Tiki Business Centre, 55 Plaza Parade
Suburb Maroochydore

State QLD

Postcode 2558

Country Australia

Email address (non-mandatory) [email protected]

Mobile number (non-mandatory)

Applicant's reference number(s) (if applicable) M1717P

 

 

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.

 

LJ Yes — the written consent of the owner(s) is attached to this change application

[1 No

 

 

 

PART 2 — LOCATION DETAILS

CJ Street address AND lot on plan (ail lots must be listed), Or

CJ 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).

Unit No. | Street No. Street Name and Type Suburb
35 Walter Hay Dr Noosaville

Postcode | Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)
2 SP162077 Noosa Council

Unit No. | Street No. Street Name and Type Suburb

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

 

Queensland
Government