Permissible Change form Signed

3. Nature of request (please tick ALL applicable catego

M To change the development
approval

 

[M Tochange the development Ol Toextend the relevant period
conditions before lapsing

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. 5 | StreetNo 50 Street

Suburb Noosa Heads State Qld Postcode 4567
Lot no. Plan type & plan no.

SP108800

   

Hastings Street

 

 

  
    

 

 

|
| :

 

 

 

 

5. Concurrence Agencies

 

Was there one or more concurrence agencies involved in the original approval? No

 

oO Yes-provide details below

Note — Under s372 of the Sustainable Planning Act 2009 the person making the request is Tequired to give a copy of this request to all
concurrence agencies.

Concurrence Agency

 

Date copy given

 

 

 

 

 

6. Pre-request response notice

 

Has a pre-request response been given by a relevant entity (e.g. a concurrence agency) for this request?
LYNo [Yes

If yes, please attach a copy of the notice.

 

 

 

WON Te Ree
Is the owner's consent required for this request? ONo

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

Table A — owner’s consent provided on form Table B — owner's consent provided on form

 

 

 

 

 

 

 

 

 

RU gsTarreer + y

Owner's name/s Rumen Hosrrnert Hee Oi Owner's name/s_ |_-—-_________
Wig THE KvTivets aed SIME TOT _ -

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

 

to the making of this request. —_

V i¢ eA hon

 

 

Signature/s

 

 

 

 

Date Voi bs \ |

 

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