Change to DA (Remove sunset clause) - MCU12/0012.02

                                                                                 Department of Infrastructure, Local Government and Planning
         i.:



Change application form
Planning Act Form 5 (version 1.0 effective 3 July 2017) made under Section 282 of the Planning Act 2016.
This form is to be used for a change an application made under section 78 of the Pfanning 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 Pfanning Act 2016 or for an 'other' change that will be assessed under section 82 of the Pfanning Act
2016.

An applicant must complete all parts of this form, and provide any supporting information that the form identifies as being
required to a=mpany      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)

 Contact name (only applicable   for companies)

 Postal address (P.o. Box or street address)               PO Box 1111
 Suburb                                                    Noosa Heads
 State                                                     Old
 Postcode                                                  4567
 Country                                                   Australia
 Email address (non-mandatory)                             [email protected]
 Mobile number (non-mandatory)                             0418874036
 Applicant's reference number(s)       (if applicable)     MCUl2/0012


 2) Owner's consent - Is wntten consent of the owner required for thiS change application?
 Note sectIOn 79(1 )(b)(lII) of the Plannmg Acf 2016 states tlJe reqwrements   In relatIOn to owner s consent

 D Ves - the written consent of the owner(s) is attached to this change a~plicetion
 X No - proceed to 3) in Part 2                                                      I                                        ~unter


PART 2 - RESPONSIBLE ENTITY DETAILS                                                  I                 ,t..      •..•
                                                                                                                   1 I [I I
 3) Identify the responsible entity that Will be assessing thiS change application
 Note see sectIOn 78(3) of the Planning Act 2016




PART 3 - CHANGE DETAILS
4) Provide details of the eXlsllng devf!lopment approval sublect to thiS change application
Approval type                        Reference number                   Date issued                             Assessment
                                                                                                                managerlapproval   entity
D Development permit                 MCUl2/0012                        4 June 2015
D Preliminary approval
D Development permit
D Preliminary approval