1. Application Form

                                                      No
                                                      Yes – pre-request response is attached to
                                                  this change application
                                                      No
                                                      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.dsdmip.qld.gov.au

    8) Location details - Are there any additional premises included in this change application that were not part of the
    original development approval?
        No
        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?
       No – proceed to 11)
       Yes – the completed Sections 1 and 2 of Part 3 (Development details) of DA Form 1 as these sections relate to
    the new or changed aspects of development are provided with this application.
    9.2) Does the change application involve building work?
       No
       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.
        No
        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
       I agree to receive an information request if determined necessary for this change application
       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 still 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
        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) change application checklist
    I have identified the:
•   responsible entity in 4); and
•   for a minor change, any affected entities; and                                                                   Yes
•   for an ‘other’ change all relevant referral requirement(s) in 10)
    Note: See the Planning Regulation 2017 for referral requirements




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