NC change form signed · OPW16/0021

4. Location of the premises
| Unit No. 'StreetNo 74 ‘Street Seaview Terrace
Suburb Sunshine Beach State Qld |Postcode 4567
Lot no. | Plan type & plan no.
4 RP197117

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

O Yes-provide details below

|Note — Under $372 of the Sustainable Planning Act 2009 the person making the request is required to give a copy of this request to all
| concurrence agencies.

Concurrence ty ; - ; : ee copy PCat

 
 

6. Pre-request response notice

| Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?
| No 0 Yes
|If yes, please attach a copy of the notice.

Oem 8

Is the owner’s consent required for this request? /O1 No

| | MW Yes— complete either Table A or Table B below
— If more than one owner of the land all owners’ details are required ae

  

     

BE Ne Reon alot a ecod Sr-Tl eed conaCe (let i011 Se aera

 

BE ICHSex VC cot Ue Neds (eR ee ee
| |

rty C Establishment | .
Unversal Property Company | Owner’s name/s

Owner's name/s

| We, the above-mentioned owner/s of the land, consent | The owner's written consent is attached.

‘to the making of this request. Y/
| Signature/s Ww
Date

40, AUG. 2016

 

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