Request to apply superseded
planning scheme
supplementary checklist
Planning and Environment
Planning Assessment
City Development
PO Box 5042 GOLD COAST MC QLD 9729
P: (07) 5582 8866 F: (07) 5596 3653
E: mail@goldcoast.qld.gov.au
W: cityofgoldcoast.com.au
Please use BLOCK LETTERS and complete all details in full
Privacy statement
Council of the City of Gold Coast (Council) is collecting your personal information in order to assess your superseded planning scheme request.
Your participation is voluntary. The information will only be used by authorised Council officers for the purpose of assessment of request and
ensuring our records are accurate. Your information will not be given to any other person or agency unless you have given us permission or we are
required by law.
Submit this completed checklist with all supporting documentation for all requests lodged under section 95 of the Sustainable Planning Act 2009.
This is not a mandatory form for the purposes of lodging a correct request under the Sustainable Planning Act 2009, however Council suggests that
this form be used in support of your request and to assist in the assessment of your request.
Property details
Lot number
Registered plan number
Property address
Mandatory information
Section 95 Sustainable Planning Act 2009 (SPA)
Completed SPA Form 2 or written request
Yes
No
Description of proposed development or copy of proposed development application or request for
compliance assessment
Yes
No
Application fees paid
Yes
No
Supplementary information
(Please provide three(3) hard copies of each item.)
Covering letter of application detailing the proposed development
Yes
No
Report identifying and assessing the proposal against Council’s nominated superseded planning
scheme
Yes
No
Plans (site plan, floor plans, elevations) drawn to scale on A3 sheet
Yes
No

(Please tick application type.)
Material Change of Use (MCU)
Compliance
assessment
Code
Impact
Reconfiguring a Lot (ROL)
Compliance
assessment
Code
Impact
Operational Works
Compliance
assessment
Code
Impact
Declaration
I declare that:
 The information provided in this form is complete and correct.
 I have read the privacy notice.
Signature
Date
Office use only
Date received
Fee paid
Received by
Receipt number
Business partner name
Account number
Business partner number
AMS code
Document #30487784 v18
Last Updated 01/07/2016
(if applicable)
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Fees

(Please tick applicable fee name)
Request for superseded planning scheme assessment
Account
number
Amount
90280
$2431.00
These fees are in accordance with Council’s regulatory fees and non-regulatory charges. A copy of these regulatory fees and
non-regulatory charges can be found on Council’s website: cityofgoldcoast.com.au
Payment Options
Business partner account (BP)
Business partner name
Business partner number
Cash, cheque or credit card at any of Council’s branch offices. For branch office locations and operating hours, please refer to
Council’s website: cityofgoldcoast.com.au
Please be advised that payments by credit card will incur a surcharge of 0.60%.
Cheque or money order may be posted to Council’s post office box address as above. Please ensure that you provide adequate
reference details or attachments to allow the cheque to be appropriately receipted.
Document# 30487784 v18
Last Updated 01/07/2016
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