CHANGES form signed · 132005.699.10

  
 

3. Nature of request (please tick ALL applicable categories)

O To change the development O To change the development LY Toextend the relevant period
approval 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. Street No 902/10 Street Serenity Close
Suburb Noosa Heads State Qld Postcode 4567
Lot no. Ce aye Mortem item

902 SP240848

 

 

 

 

 

 

5. Concurrence Agencies
Was there one or more concurrence agencies involved in the original approval? No
OQ Yes-provide details below

Note — Under s372 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 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?
No | O Yes

If yes, please attach a copy of the notice.

 

 

 

 

reel Tiamat §

 

Is the owner’s consent required for this request? ONo
8 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
CED SETTLERS CVE Pri cD
(SHAWNON _GLLAeD_Po.A)

We, the above-mentioned ownet/s of the land, consent 0) The owner’s written consent is attached.
to the making of this request.
ALA

Signature/s WUMGEAs

 

 

 

 

 

 

 

Owner's name/s Owner's name/s

 

 

 

 

 

 

 

 

 

 

 

Date ou [rofl

 

 

 

 

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