Img_2970.Jpg · 51995.1490.06

 

 

 

  

    
  
    

  
   

DPANED Boss WHITTLS Unsert full name.)

[/nsert street address, lot on plan description or coordinates of the premises the subject of the
application.|

2/3 PARK EDEE RoAD, Sunswne BEACH , ¥Se7.

OS ee [insert name of applicant |

on the premises described above for:

   
 
 

    
   

Unsert details of the proposed development, e.g. material change of use for four storey apartment
building.|

{signature of owner and

pt ae