DA Form 5

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    ☐ 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                       Date notice given (where no
                                                  pre-request response notice for the application has been      pre-request response provided)
                                                  given, a copy of the notice must accompany this change
                                                  application)
                                                  ☐ No
                                                  ☐ Yes – pre-request response is attached to
                                                     this change application
                                                  ☐ 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 – 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.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

    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
    ☐ 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?
    ☐ No
    ☐ 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
          development application including the proposed change.
    ☐ No
    ☐ 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
    ☐ 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.


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