NC Changes form · 132007.799.1

 
    

3. Nature of request (please tick ALL applicable categories)

"MW To change the development O Tochange the development O To extend the relevant period
l approval ! conditions before lapsing

ne Ss ee 2 encanta reemee

  

  

 

| | Please attach documentation outlining the detail of and the reasons and justification for the » requested change or
‘extension.

4. Location of the premises

; Unit No. Street No 15 Street Grant Street
; Suburb Noosa Heads State Qld Postcode 4567

 

 

[L 0 7 " §P226607

 

   

5. Concurrence Agencies
| Was there one or more concurrence agencies involved in the original approval?

  
  
     

   
 

vide details below

 

|

iNote— Under 8372 of the Sustainable Planning Act 2009 the person making ti the request i is Tequired to give a copy of this | request to all
concurrence agencies.

 

  

6. Pre-request response notice
H; sa pre-request response been given bya relevant entity (e. g. a concurrence agency) for this request? —

  
 

7. Owner’s consent
‘Is the owner's consent required for this request? re
ee MW! Yes— complete either Table A or Table B below

Note - ifn If more than on one owner of the land all owners’ details are required

   

 

   

: Owner's name/s

et, sa ‘3 '
We tAie/) Owner's name/s i

“Me, tk the above-mentioned owner/s of the land, consent | la The ov owner's written consent i is attached.
to the making of this'request. _ ; an

7
Signature/s bin XG

  
  

Date

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