DA Form 5 · 132001.210331.6

PART 5 — MINOR CHANGE APPLICATION REQUIREMENTS

7) Are there any affected entities for this change application

 

re — proceed to Part 7

Yes — list all affected entities below and proceed to Part 7

Note: section 80(1) of the Planning Act 2016 states that the person making the change application must give notice of the proposal and the
details of the change to each affected entity as identified in section 80(2) of the Planning Act 2016.

 

Affected entity Pre-request response provided? (where a pre- Date notice given (where no pre-
request response notice for the application has been request response provided)
given, a copy of the notice must accompany this change
application)

 

EINo

U1 Yes ~ pre-request response is attached to
PFRSESTMENT MAN iat this change application
C1No

O Yes - pre-request response is attached to
this change application

[No

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 — Development application details and in some instances parts
of DA Form 2 — Building work details, as mentioned below. These forms are available at https://planning. dsdmip.qid.gov.au.

8) Location details - Are there any additional premises included in this change application that were not part of the
original development approval?

 

 

9) Development details

9.1) Is there any change to the type of development, approval type, or level of assessment in this enn
application?
LCINo
C1 Yes ~ the completed Sections 1 and 2 of Part 3 (Development details) of DA Form 1 — Development application
details 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?

LNo

CO Yes - the completed Part 5 (Building work details) of DA Form 2 — Building work details 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
Nelo dara) oy ee lelg Male Ue aeR proposed change.

LC No
0 Yes - the completed Part 5 (Referral details) of DA Form 1 — Development application details 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

[1 | agree to receive an information request if determined necessary for this change application

[1 | 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:

 

 

 

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Planning Act Form 5 - Change application form
Version 1.2 — 7 February 2020