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IDLEWILD MULTIPLE PROPERTIES� ' 2017 N Betty LN ANX2014-03007 1 Idlewild Muitiple Properties Zoning: Atlas #: o �� , > � �4 ��1 ri a��,� ..,,� U Planning & Development Department Petition for Annexation ALL APPLICATIONS ARE TO BE FILLED OUT COMPLETELY AND CORRECTLY, AND SUBMITTED IN PERSON (NO FAX OR DELIVERIES) TO THE PLANNING & DEVELOPMENT DEPARTMENT BY NOON ON THE SCHEDULED DEADLINE DATE. A TOTAL OF 14 COMPLETE SETS OF APPLICATION AND SUPPLEMENTAL MATERIALS (1 ORIGINAL AND 13 COPIES) AS REQUIRED WITHIN ARE TO BE SUBMITTED FOR REVIEW BY THE DEVELOPMENT REVIEW COMMITTEE. APPLICATIONS AND SUPPLEMENTAL MATERIALS ARE REQUIRED TO BE COLLATED AND STAPLED INTO SETS. IT IS INCUMBENT UPON THE APPLICANT TO SUBMIT COMPLETE AND CORRECT INFORMATION. ANY MISLEADING, DECEPTIVE, INCOMPLETE OR INCORRECT INFORMATION MAY INVALIDATE YOUR APPLICATION. THE APPLICANT, BY FILING THIS APPLICATION, AGREES TO COMPLY WITH ALL APPLICABLE REQUIREMENTS OF THE COMMUNITY DEVELOPMENT CODE. APPLICATION FEE: IMPACT FEE/ASSESSMENT FEE: PROPERTY OWNER (PER DEED): MAILIN6 ADDRESS: $0 TBD lnformation on Impact Fees orAssessment Fees is available from the City of Clearwater Engineering Department (562-4747). PHONE NUMBER: Z� � -"(� �'7 - � y .3� EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: PARCEL NUMBER(S): �-j�ss LE6AL DESCRIPTION: �Q�_ ��--5 � '� C�� n -�- � CURRENTCITYSERVICES: SANITARYSEWER REQUESTEDCITYSERVICES: � SANITARYSEWER (select a!1 that apply) � SOLID WASTE � WATER �SOLID WASTE Pianning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 1 of 7 Revised 03/13 � � � s��a�rwater ��. Planning & Development Department Petition for Annexation ► � -�Q,�n �,��r� Disclosure Statement PROPERTY OWNER (PER DEED): I�� ' � s�-�-�� .�., C j e�,,�,� ��.�r F � MAILIN6 ADDRESS: 3� j %S3'" PHONE NUMBER: 7 �� "') —� (� �` 7 •— g ° � � EMAIL: AGENT OR REPRESENTATIVE: MAILIN6 ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: INTEREST IS: SPECiFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBIECT PROPERTY? CONTRACT IS: PARTIES INVOLVED — NAME: NAME: ARE THERE ANY OPTIONS TO PURCHASE THE SUBIECT PROPERTY? PARTIES INVOLVED — NAME: IVHIVIC: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBIECT PROPERTY? PARTIES INVOLVED — NAME: NAME: _ YES � NO PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: 1'fIVIVC IVVIVIDCR. � YES PHONE NUMBER: PHONE NUMBER: NO m STATE OF fLORIDA, COUNTY OF PINELLAS I(we), the undersigned, acknowledge that ail representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application. Sworn to and subscribed before me this C�-] day of / I ? �, �.� , � � . by ature of property owner or representative who is personally known/has roduced �f�7_ C-2�' ��'3—b�i�3� as identification. Notary c, My commission expires: Notary Public State of florida Signature of property owner or representative '!y� c�, ,p� n,ty C«nm�sswn FF oas3os "+apd' Expires t0/t5/2017 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 5 of 7 Revised 03/13 LL � ::-' t ; �:.. o Planning & Development Department � Clearwater - - - Petition for Annexation � Data Sheet PLEASE ENSURE THAT THE FOLLOWING INFORMATION IS FILLED OUT, IN ITS ENTIRETY. FAILURE TO COMPLETE THIS FORM WILL RESULT IN YOUR APPLICATION BEING FOUND INCOMPLETE AND POSSIBLY DEFERRED UNTIL THE FOLLOWING APPLICATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY): REQUESTED (CITY): ZONING DISTRICT PRESENT (COUNTY): REqUESTED (CITY): SITE AREA: v �' � acres SIZE OF DEVELOPMENT : Existing: _ Proposed: (e.g., number of units, hotel rooms or non- residential square footage) USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; plus existing if to remain): If residential use, is unit(s) rentai? � �T`�[�� G �' Ci�f1'll �i� ��m� a,�(,,� r? STATE OF FLORIDA, COUNTY OF PINELLAS I(we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application. �/ Sworn to and subscribed before me this � 7 day of � � • _?��. bv who is personally known/has produced �(�L �2'x' r7s C�,� �� as identification. of property owner or represe N OI�T�{-6TJ p I I C, ��. , My commission expires Signature of property owner or representative Notary PuWic State of Floride ar � My Commissio� FF 046309 ' Exoirss 1 011 512 01 7 Planning 8 Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 2 of 7 Revised 03/13 0 a�*�, ° � ��- rwat�r � .:�,a:� U � Planning & Development Department Petition for Annexation ALL APPLICATIONS ARE TO BE FILLED OUT COMPLETELY AND CORRECTLY, AND SUBMITTED IN PERSON (NO FAX OR . DELIVERIES) TO THE PLANNING & DEVELOPMENT DEPARTMENT BY NOON ON THE SCHEDULED DEADLINE DATE. A TOTAL OF 14 COMPLETE SETS OF APPLICATION AND SUPPLEMENTAL MATERIALS (1 ORIGINAL AND 13 COPIES) AS REQUIRED WITHIN ARE TO BE SUBMITTED FOR REVIEW BY THE DEVELOPMENT REVIEW COMMITTEE. APPLICATIONS AND SUPPLEMENTAL MATERIALS ARE REQUIRED TO BE COLLATED AND STAPLED INTO SETS. IT IS INCUMBENT UPON THE APPLICANT TO SUBMIT COMPLETE AND CORRECT INFORMATION. ANY MISLEADING, DECEPTIVE, INCOMPLETE OR INCORRECT INFORMATION MAY INVALIDATE YOUR APPLICATION. THE APPLICANT, BY FILING THIS APPLICATION, AGREES TO COMPLY WITH ALL APPLICABLE REQUIREMENTS OF THE COMMUNITY DEVELOPMENT CODE. APPLICATION FEE: IMPACT FEE/ASSESSMENT FEE: PROPERTY OWNER (PER DEED) MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: $0 TBD lnformation on Impact Fees orAssessment Fees is available from the City of Clearwater Engineering Department (562-4747). � � '�Vill �arl� � ' " _ _ �.-- . . , , < _„ . „ : — -_ _ ,-,_, -- • • —� �%it -�`� c� ;.j'' � _ ' � ,i s t .� r MAILING ADDRESS: � 7 % � ' � �� - �' �i� ��, - � �f %v� �' �= �� % � PHONE NUMBER: 7-; 7-�'� ; J EMAIL: ADDRESS OF SUBJECT �� ` PROPERTY: �. ?J � � 'JV • PARCEL NUMBER(S): r') �, -�,- i 5 - � � LEGALDESCRIPTION: ��,�., ��r �, �j��' �(; !-c:�" '=� CURRENT CITYSERVICES: SANITARY SEWER SOLID WASTE �� WATER REQUESTED CITYSERVICES: �;� SANITARY SEWER SOLiD WASTE (select ali that apply) T Planning 8 Development Department, 100 S. Myrtle Avenue, Ciearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 1 of 7 Revised 03113 o z� � Planning & Development Department > ��e Petition for Annexation � � Data Sheet PLEASE ENSURE THAT THE FOLLOWING INFORMATION IS FILLED OUT, IN ITS ENTIRETY. FAILURE TO COMPLETE THIS FORM WILL RESULT IN YOUR APPLICATION BEIN6 FOUND INCOMPLETE AND POSSIBLY DEFERRED UNTIL THE FOLLOWING APPLICATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY): REQUESTED (CITY): ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): SITE AREA: �/ ' //C SIZE OF DEVELOPMENT : Existing: _ Proposed: (e.g., number of units, hotel rooms or non- residentiol square footage) �v l') �% acres 0 USE OF PROPERTY: Existing (currently on site): S,�� e .�,;,, .�i ��v✓i-� Proposed (new use, if any; r / plus existing if to remain): `/ ?- �� i� rn, I lfvrne If residential use, is unit(s) �/ rentai? 1�V �� STATE OF FLORIDA, COUNTY OF PINELLAS I(we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this applicatj Sworn to and subscribed before me this � day of �--- ,��' .by Signature of property owner or � ,'ti�'�'e��;. P'r'tULAFAKIOLAS ,:�,... `; ; � ;= Ccmmis��o� # D� 984778 � � <;�!..';- �x�iros May 22, 2014 � r, fscn.�J fhr�Troyrain;�urance800•38.`,=;0?5 Sign atuare�of''pto"pertyowne r�"`r'�'�"se�'a"'�i produced(/L.L T I t,(Y�► � � �JC� - �08 -- 5 � otary public, My commission expires: / � who is personally known/has l�C�)� identification. � - �j l�ar' �. ._-� �►a , a� � � Planning 8 Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 2 of 7 Revised 03/13 ° � � ater � ��r�w � PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: Planning & Development Department Petition for Annexation Disclosure Statement OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBIECT PROPERTY: NAME: INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? CONTRACT IS: PARTIES INVOLVED — NAME: NAME: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? PARTIES INVOLVED — NAME: IVNIVIC: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? PARTIES INVOLVED — NAME: NAME: �i' 3 � 7 YES �/ NO PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: rriviv� iviiivioEn: � YES PHONE NUMBER: PHONE NUMBER: NO NO STATE Of FLORIDA, COUNTY OF PINELIAS I(we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this applic io Sworn to and subscribed before me this day of � � aD b � .Y � C1 who is personaily known/has i� �,�,..--.. nrnrlucPd I.i �I'�iL1DY.0 �./��-�s identification. �ignatur �g, . av� er or re resentative ,:�:��ei%;-, P�,ULAFAKIOLAS =:,:�j ;.: C� �mrn�s,io� � �# DD 984778 �.k''�' r�; Ex;�i3es May 22, 2014 .�r c f��at�1 �'h.ttTroy�amirsu2nCe8�-385=lC18 Signature of property owner or representative Not�ry public, My commission expires: ��!GiL'ii�i�T Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 5 of 7 Revised 03l13 � ��= rwater � � � �� U PROPERTY OWNER (PER DEED): MAILING ADDRESS: CITY OF CLEARWATER CASE NUMBER: Planning & Development Department Petition for Annexation Sunnlemental Statement I/we, [insert names of all property owners], having filed a Petition for Annexation regarding the above property/case number, grant consent, agree and acknowledge that the City of Clearwater may immediately or at a later time process the application to completion, including adoption and recordation of related Ordinances, without the necessity to further notice me/us. This Supplemental Statement shall supersede any provision in any Agreement to Annex executed by me/us or my/our predecessors in interest. I/we further agree and acknowledge that I/we shall not rescind the Petition for Annexation or execute any documents attempting such rescission, and that any attempted rescission shall be of no force and effect. STATE OF FLORIDA, COUNTY OF PINELLAS 1(we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application.� Sworn to and subscribed before me this L� day of Signature of property owner (individual or authorized representative of corporation, partnership or other � entity) Signature of co-property owner produced �� (�otary public, My commission expires: [�>��_. by who is personally known/has �asj,dentification. � �,,,��;, �.,v=.. ,�,zQ.:��p�a4., �f,u�i �Ai<ioi..as :�: *= �omm;ssio,+# OD 984778 :;�, .�,o�: �;�ires May 22, 2094 P, j;,;;:•`°� 6erded TMu 7ruy Fain ��sura� 800�385-7015 . ...,.;,�,'.+4c.°..rsaxc:v-.�..•;.-�=rn�m`. � � Planning & Development Department, 100 S. Myrtle Avenue, Ciearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 7 of 7 Revised 03/13