Change to DA (Amend/Remove condition 3 - 195 to 210 EGM's) - MCU16/0079.04

                                              0 Yes — pre-request response is attached to
                                              this change application

  PART 6- OTHER CHANGE APPLICATION REQUIREMENTS
  Note: to complete this part it will be necessary for you to complete parts of DA Form 1 and in some instances parts of DA Form
  2, as mentioned below. These forms are available at https://planning.dsdnnip.q1d.gov.au

8) Location details - Are there any additional premises included in this change application that were not part of the
ori.inal develo.ment a. 'royal?
O No
El Yes — complete Part 2 (Location details) of DA Form 1 as it relates to the additional premises is completed and
provided with this application.

9) Development details
9.1) Is there any change to the type of development, approval type, or level of assessment in this change application?
I0 No — proceed to 11)
O Yes — the completed Sections 1 and 2 of Part 3 (Development details) of DA Form 1 as these sections relate to
the new or chan.ed aspects of development are provided with this application.
9.2) Does the change application involve building work?
▪ No
O Yes — the completed Part 5 (Building work details) of DA Form 2 as it relates to the change application is provided
with this application.

10) Referral details — Does the change application require referral for any referral requirements?
Note: The application must be referred to each referral agency triggered by the change application as if the change application was the original
development application including the proposed change.
O No
El Yes — the completed Part 5 (Referral details) of DA Form 1 as it relates to the change application is provided with
this application. Where referral is required for matters relating to building work the Referral checklist for building work
is also completed.

11) Information request under Part 3 of the DA Rules
O I agree to receive an information request if determined necessary for this change application
0 I do not agree to accept an information request for this change application
Note: By not agreeing to accept an information request I, the applicant, acknowledge:
that this change application will be assessed and decided based on the information provided when making this change application
and the assessment manager and any referral agencies relevant to the change application are not obligated under the DA Rules to
accept any additional information provided by the applicant for the change application unless agreed to by the relevant parties
Part 3 of the DA Rules will stN apply if the application is an application listed under section 11.3 of the DA Rules.
Further advice about information requests is contained in the DA Forms Guide: Forms 1 and 2.


12) Further details
0 Part 7 of DA Form 1 is completed as if the change application was a development application and is provided with
this application.

 PART 7- CHECKLIST AND APPLICANT DECLARATION
13 chanie a..lication checklist
I have identified the:
responsible entity in 4); and
for a minor change, any affected entities; and                                                               x0 Yes
for an 'other' change all relevant referral requirement(s) in 10)
Note: See the Planning Regulation 2017 for referral requirements
For an 'other' change application, the relevant sections of DA Form 1 —
Development application details have been completed and is attached to this
                                                                                                             El Yes
                                                                                                             X0 Not applicable
application
For an 'other' change application, where building work is associated with the                                El Yes
change application, the relevant sections of DA Form 2 — Building work details                               X0 Not applicable


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                                                                                                   Planning Act Form 5 - Change application form
                                                                                                                   Version 1.1 —22 JUNE 2018