Planning Act Form 5-Change application form

Change application form
Planning Act Form 5 (version 1.1 effective 22 JUNE 2018) made under Section 282 of the Planning Act 2016.
This form is to be used for a change application made under section 78 of the Planning 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 Planning Act 2016 or for an ‘other’ change that will be assessed under section 82
of the Planning Act 2016.
An applicant must complete all parts of this form, and provide any supporting information that the form identifies as
being required to accompany 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
1) Applicant details
Applicant name(s) (individual or company full name)                   Noosaville Medical and Professional Centre Pty Ltd
Contact name (only applicable for companies)                          Shane Adamson C/- Adamson Town Planning
Postal address (P.O. Box or street address)                           PO Box 78
Suburb                                                                Peregian Beach
State                                                                 QLD
Postcode                                                              4573
Country                                                               AUSTRALIA
Email address (non-mandatory)                                         [email protected]
Mobile number (non-mandatory)                                         0437754420
Applicant’s reference number(s) (if applicable)                       16014

2) Owner’s consent - Is written consent of the owner required for this change application?
Note: section 79(1A) of the Planning Act 2016 states the requirements in relation to owner’s consent.
 Yes – the written consent of the owner(s) is attached to this change application
    No


PART 2 – LOCATION DETAILS

3) Location of the premises (complete 3.1) or 3.2), and 3.3) as applicable)
3.1) Street address and lot on plan
 Street address AND lot on plan (all lots must be listed), or
    Street address AND lot on plan for an adjoining or adjacent property of the premises (appropriate for development in
water but adjoining or adjacent to land e.g. jetty, pontoon; all lots must be listed).
         Unit No.    Street No.       Street Name and Type                                    Suburb
                     101              Eumundi Noosa Road                                      Noosaville
a)
      Postcode       Lot No.          Plan Type and Number (e.g. RP, SP)                      Local Government Area(s)
                     1                RP230931                                                Noosa
      Unit No.       Street No.       Street Name and Type                                    Suburb
                     105              Eumundi Noosa Road                                      Noosaville
b)
      Postcode       Lot No.          Plan Type and Number (e.g. RP, SP)                      Local Government Area(s)
                     1                RP849431                                                Noosa
3.2) Coordinates of premises (appropriate for development in remote areas, over part of a lot or in water not adjoining or adjacent to land
e.g. channel dredging in Moreton Bay)
Note: Place each set of coordinates in a separate row. Only one set of coordinates is required for this part.
   Coordinates of premises by longitude and latitude
Longitude(s)             Latitude(s)               Datum                                             Local Government Area(s) (if applicable)
                                                      WGS84
                                                      GDA94
                                                      Other: