Application Form

Change application form
Planning Act Form 5 (version 1.2 effective 7 February 2020) made under Section 282 of the Planning Act 2016.

 

This form is to be used for a change application made under section 78 of the Planning Act 2016. It is important when
making a change application to be aware of whether the application is for a minor change that will be assessed under
section 81 of the Planning Act 2016 or for an other change that will be assessed under section 82 of the Planning Act
2016.

An applicant must complete all parts of this form, and provide any supporting information that the form identifies as
being required to accompany the change application, unless stated otherwise. Additional pages may be attached if
there is insufficient space on the form to complete any part.

Note: All terms used in this form have the meaning given under the Planning Act 2016, the Planning Regulation 2017, or the Development
Assessment Rules (DA Rules).

PART 1 — APPLICANT DETAILS

Applicant name(s) (individual or company full name) Palm Lake Works Pty Ltd

Contact name (only applicable for companies) Sara Burston
Postal address (P.O. Box or street address) PO Box 10479
Suburb Southport
State QLD
Postcode 4215

Country Australia

Email address (non-mandatory) [email protected]
Mobile number (non-mandatory) 0483345300"
Applicant’s reference number(s) (if applicable)

2) Owner's consent - Is written consent of the owner required for this change application?
Note: Section 79(1A) of the Planning Act 2016 states the requirements in relation to owner's consent.

Wres — the written consent of the owner(s) is attached to this change application

OO No

 

 

PART 2 — LOCATION DETAILS

XI Street address AND lot on plan (ail ots must be listed), or

OO Street address AND lot on plan for an adjoining or adjacent property of the premises (appropriate for development in
water but adjoining or adjacent to land e.g. jetty, pontoon. All lots must be listed).

Unit No. | Street No. Street Name and Type Suburb

284 Lamonts Road Cooroy
Postcode | Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)
4563 1&4 RP 215922 Noosa Shire Council
Unit No. | Street No. | Street Name and Type Suburb

19 & 20 Trading Post Road Cooroy
Postcode | Lot No. Plan Type and Number (e.g. RP, SP) Local Government Area(s)
4563 1&2 RP 165418 Noosa Shire Council

a)

 

Queensland
Government