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Online Form - Application for Variation of Certificate of Approval

A confirmation message will appear once the form is submitted please retain this as evidence of submission.

If you have any questions or concerns with the application process please contact Shire of Exmouth Environmental Health Services on 9949 3000.

Please tick the box below applicable to your application *

Permanent VariationTemporary VariationChange of Ownership

Have you received planning advice and approval? *

YesNo

Building Approval Number *

Site Map/Building Plans

Please upload as much detail as possible including but not limited to exit widths, toilets, ventilation, structures, licensed area and available floor space (no hand drawn plans will be accepted)

Document 1

Maximum size of ALL attachments is 976.56 MB

Document 2

Maximum size of ALL attachments is 976.56 MB

Document 3

Maximum size of ALL attachments is 976.56 MB

Details of Engineering for Structures

Maximum size of ALL attachments is 976.56 MB

Electrical Compliance Form - All new installations need to be signed off using this form by electrician

Maximum size of ALL attachments is 976.56 MB

Copy of Liquor License

Maximum size of ALL attachments is 976.56 MB

Marquee Checklist

Maximum size of ALL attachments is 976.56 MB

Additional Entertainment Details

Premise Details

Name *

Address *

Nearest cross street *

Reason for this variation from the Certificate of Approval *

Contact Details

Name of Owner/Agent

Address *

Phone/Mobile *

Fax

Declaration

In support of this application i tender the following details as required *

Date *

Declaration *

I declare that I am the person named as applicant on the above form and that the information contained in this application is true & correct in every particular

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