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ANX2014-09016f• 1215 UNION ST ANX2014-09016 1 Idlewild - Multiple Properties p Zoning: Atlas#:251B � � �i+1�1 7 � s+rtiv� U Planning & Development Department Petition for Annexation ALL APPLICATIONS ARE TO SE FILLED OUT COMPLETELY AND CORRECTLY, AND SUBMITTED IN PERSON (NO FAX OR DELIVERIES) TO THE PLANNIN6 & DEVELOPMENT DEPARTMENT BY NOON UN THE SCHEDUIED DEADUNE DATE. A TOTAL OF 14 COMPLETE SETS OF APPUCATION AND SUPPLEMENTAL MATERIAtS (1 OR161NAL AND 13 COPIESj AS REQUIRED WITHIN ARE TO BE SUBMlTTED FOR REVIEW BY THE OEVELOPMENT REVtEW COMMITTEE. APPLICATtONS AND SUPPLEMENTAI MATERIALS ARE REQUIRED TO BE COLLATED AIVD STAPLED INTO SETS. IT IS INCUMBENT UPON THE APPUCANT T� SUBMIT COMPLETE AND CORRECT INFORMATION. ANY MISLEADING, DECEPTIVE, INCOMPLETE OR iNCORRECT INFORMATION MAY INVAUDATE YOUR APPLlCATION. THE APPLICANT, BY FiUNG THIS APPLICATION, AGREES TO COMPLY WITH ALL APPIICABLE REQUIREMENTS OF THE COMMUNITY DEVELOPMENT CODE. APPIICATIOW FEE: $� tMPACT FEE/ASSESSMENT FEE: TBD Inf�m►ation on lmpact Fees arAssessment Fees is available fi��m the City of Clearvvater Engineering Dspa�trr�nt (562-4747). PROPERT1f OWNER (PER DEED): Joseph L. 2eller MAILild6 ADDRESS: 1030 Osage Street, Clearwater, FL 33755-1836 PHONE NUMBER: �'�.� 3 6,�'"7��'(02 EMAIL• Ze 2�CON5 , Y�i(tfL d c�vt? A6ENT OR REPRESENTATIVE: MAIIING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 1215 Union Street, Clearwater, Fl 33755 PROPERTY: PARCEL NUMBER(5): 03-29-is-15840-001-0100 LE6Al DESCRIPTION: Cleardun elk A, lot 10 CURRENT CIiYSERVICES: SANITARY SEWER REQUE3TED C►7YSERVICES: � SANITARY SEWER (seled ail that opply) SOLID WASTE �_ SOLfD WASTE X WATER PYann"mg 8 Developroent DePertment, 100 S. Myrtie Avenue. Clearw�te�' �" 33756, TeL• T27-562�567; Fax: R�� 3 Pa� 1 of 7 � • ° l�arwater r � U Planning & Development Depai-dnent Petition for Annexation Data Sheet PLEASE ENSURE THAT THE FOLLOWING INFORMATION IS FILI.ED OUT, IN ITS ENTIRETY. FAILURE TO COMPLETE THIS FORM WILI RESULT IN YOUR APPLICATION BEIN6 FOUND INCOMPLETE AND POSSIBLY OEFERRED UNTIL THE FOLLOWING APPLfCAT10N CYCIE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTYj REQUESTED (CITY) ZONIN6 DISTRICT Residential Urban (RU) Residential Urban (RU) PRESENT (COUNTY): R-4, One, Two and Three Family Residential REQUESTED (CITY): Low Medium Density Residentiaf (LMDR) SITf AREA: 0.141 acres S1ZE OF DEVELOPMENT : Existing: Proposed: 1 (e.g., number af uniis, hotel rooms or non- residentiat square footage) USE OF PROPERTY: Existing (currentiy on site): Single Family Dwelling Proposed {new use, if any; plus existing if to remain): If residential use, is unit(s) rental? Single Family �welling STATE OF FLORIDA, COUNTY OF PINELLIIS I(we), the undersigned, acknowledge that all representations made in this application are true and accu�ate to the best of my knawledge and au#horize City representatives to visit and photograph the property described in this applicati , Sworn ta and subscribed before me this day of , ��' by � � � �� , who is er � aU�t.icnpy�r�/has of pr�perty owner o�representative Signature of property owner or representative Planning 8 Developmetrt Departrne�rt,100 S. Myrtte Page 2 of 7 produced ary public, commission expires: JQ � -_._"'�'�'� �!' P+rblk . a � � Conn�, � J� f 201A w- - MM. r-- as identification. i 72T-562-d�5 Revised 03/13 -- _ ___ ._ . � � ° lear�vat�r �� U PROPERTY OWNER (PER DEED�: MAILING ADDRESS: PHONE (dUMBER: EMAtL: AGENT OR REPRESENTATIVE: MAIUNG ADDRESS: PHONE NUMBER: EMAIL: Planning & Development Department petition for Annexation Disclosure Statement � 5f �, ^� �,' Q� t' 1030 Osage Street, Clearwater, FL 33755-1836 OTHER PERSONS HAVING ANY OWNERSHIP tNTEREST IN THE SUBIECT PROPERTY: NAME: INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SACE OF THE SUBJECT PROPERTY? CONTRACT IS: PARTIES INVOLVED — NAME: NAM E: YES PHONE NUMBER: PHONE NUMBER: � • ARE THERE ANY OPTIONS TO PURCHASE THE SUB1EtT PROPERTY? YES �_ NO PHONE NUMBER: PARTIES INVOLVED — NAME: pHONE NUMBER: IVAM E: ARE THERE ANY MORT6AGES OR LIENS ON THE SUBIECT PROPERTY? YES I� N� PHONE NUMBER: PARTIES INVOLVED — NAME: pNONE NUMSER: NAME: STATE OF FLORIDA, G�UNTY OF PINELLAS I(we), the undersigned, acknowledge that all representatians made in this application are true and accurate to the best of my knowiedge and authorize City representatives to visit and photograph the property described in this application. ��. � �ay of Sworn to and subscribed before me this 4_ �'—_=___ � .� i f3��1_1/J�"` J ��1�-- bY f� � Ra d11J1 M% ��,� , who is persanaily kno,v„�/has � // � _ /%� . , a� s identification. of' operty owner or representative Nb�ry public, Mycommissio�► expires: Signature of property owner or representative Pfanning � Development DeParfinerrt.100 S. Myrtle Page 5 of 7 (� .' i '� C7�C� � JC �IIIN �� c:727-562-4865 �p � 4. �� Revised 03/13 t � t� ° �learwa�er � Planning & Development Department Petition for Annexation U Supplemental Statement PROPERTY OWNER (PER DEED): Joseph L. Zeiler MAILING ADDRESS: 1030 Osage Street, Clearwater, FL 33755-1836 CITY QF CLEARWATER CASE NUMBER: 1/we, .,► � �-2 � r �. G---� � (/i� (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 appiication to completion, including adoption and recordation of related Ordinances, without the necessity to further notice me/us. This Supplemental Statement shali 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(wej, the undersigned, acknowledge that all representations made in this appiication 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 day of _��L_• bY � _ � � �� who is personally known/has Sign�Gre of prop(�rty owner {individual or authorized representative of corporation, partnership or other entityj Signature of co-pfoperty owner produced a�jr public, commission expires: as identification_s '"'�f�°� � !lJ �i �'� �MAN . �nr �'+wre • tw a po�w, ' Mr'�C'"'�. �w-,M,:. m�e �r T�nrM wr�w tree0 Mai. Pianning � Devetopme� Deparbmerrt,100 S. Myrtle Avenue, Clearwatier, FL 33756, Tel: T27�62�t567; Fax: 727-562-4865 !'age T of7 Revised Q3l13 r 1215 UNION ST ANX2014-09016 1 LL Idlewild - Multiple Properties � Zoning: ' _�..� r r wrvl U Atlas #: 251 B Planning & Development Department Petition for Annexation ALL APPLICATIONS ARE TO BE FILLED OUT COMPLETELY AND CORRECTLY, AND SUBMITTED IN PERSON (NO FAX OR DEIIVERIES) TO THE PLANNING & DEVELOPMENT DEPARTMENT BY NOON ON THE SCHEDULED DEQDLINE 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 COLIATED 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: S� IMPACT FEE/ASSESSMENT FEE: TBD Information on Impact Fees orAssessment Fees is available from the City of Clearwater Engineering Department (562-4747). PROPERTY OWNER (PER DEED): Barbara C. Green MAILING ADDRESS: 1101 Fairburn Avenue, Clearwater, FL 33755-3319 PHONE NUMBER: EMAIL: barbgreen@ethep.or� AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 1301 Idlewild Drive, Clearwater, FL 33755 PROPERTY: PARCEL NUMBER(S): 03-29-15-12060-011-0010 LEGAL DESCRIPTION: Brooklawn Blk K, Lot 1 CURRENT CITYSERVICES: SANITARY SEWER SOLID WASTE REQUESTEDCITYSERVICES: ✓ SANITARYSEWER � SOLIDWASTE (select all that applyJ � WATER Pianning 8 Development Department, 100 S. Myrtle Avenue, Ciearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 1 of 7 Revised 03/13 0 ° Clearwater � Planning & Development Department 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 PIAN DESIGNATION SITE AREA: PRESENT (COUNTY): Residential Urban (RU) REQUESTED (CITY): Residential Urban (RU) ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): 0.116 SIZE OF DEVELOPMENT : Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residential square footage) R-4, One, Two and Three Family Residential Low Medium Density Residentiai (LMDR) acres USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; plus existing if to remain): If residential use, is unit(s) rental? Single Family Dwelling Single Family Dwelling STATE OF FLOR�DA, 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 � ��` day of � s�Lt "'►' ._bY____ _ ��, `� �(�1t C, (�-� en , who personally known/ as �______ � produced as identification. Signature of property owner or representative Signature of property owner or representative Notary public, i / My commission expires: REBECCA LE1T �w..�� rY{Ary' J{OIV Vl r1VIN� My Comm. E�ires Jan 1. 2016 Canmisslon � EE 1S715Q 18eded Thrcuoh NalionN Not�r btn Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 2 of 7 Revised 03/13 r, ✓ ° Clearwater � PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: Barbara C. Green 1101 Fairburn Ave Planning & Development Department Petition for Annexation Disclosure Statement Clearwater, FL 33755-3319 OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: ��/L NAME: �� INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? YES NO CONTRACT IS: PARTIES INVOLVED – NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? YES V NO PARTIES INVOLVED – NAME: NAME: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? PARTIES INVOLVED– NAME: NAME: PHONE NUMBER: PHONE NUMBER: YES V NO PHONE NUMBER: PHONE NUMBER: 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 �� day of o�e:%! . by_.. ,,\.� T l'" � el"1 who is onall know as I�er�. ___. �L __� - - —''> produced „ as identification. Signature of property owner or representative Notary public, My commission Signature of property owner or representative Pianning & Development Department, 100 S. Myrtle Avenue, C Page 5 of 7 res: �-(iL.L%L.�.% REBECCA LETT ADAMS �' s�� donded TMOUph Natlon�l MOtxv � Z�� 03l13 ° Clearwater Planning & Development Department Petition for Annexation � Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed — PRINT full names: Barbara C. Green 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 130( 1 a�ul�w r�JE-, c.�c�a-�J �z, � 3. That this property constitutes the property for which a request for (describe request): S�rti1 ��,R�-i S�J�R- �J p sv t-t- D W A'�T� 4. That the undersigned (has/have) appointed and (does/do) appoint: �1�� as (his/their) agent(s) to execute any petitions or other documents necessary to affect such petition; 5. That this affidavit has been executed to induce the City of Clearwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by City representatives in order to process this application and the owner authorizes City representatives to visit and photograph the property described in this application; ,Z�� the undersigned authority, hereby certify that the foregoing is true and correct. �� Property Owner Property Owner Property Owner STATE OF FLORIDA, COUNTY OF PINELLAS Property Owner BEFORE ME THE UNDERSIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON THIS lX� DAYOF o 11.��U._� �l PERSONALLYAPPEARED ;'�,.._.r _� n..�__ WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. ,,�P,;;'p��, RFBECCA LETT ADAMS � : a°. .`�'s Notary Public - State of Florida ji : _ My Comm. Expires Jan 4, 2016 `�� j C� : ' `' Commission # EE 157t50 � ;� �;°� Notary Public Signature '��°� ��`'� Bonded Throuqh Nabonal Notary Assn. � Notary ea Stamp My Commission Expires: �i�(�_�, {� �—�- ; Z�;i („�� Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 6 of 7 Revised 03/13 ° �learwater U PROPERTY OWNER (PER DEED): Barbara C. Green Planning & Development Department Petition for Annexation Supplemental Statement MAILING ADDRESS: 1101 Fairburn Avenue, Clearwater, FL 33755-3319 CITY OF CLEARWATER CASE NUMBER: I/we, ��-�rq�-r� � f�� [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 Ciearwater 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. �/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 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 applicatio� Sworn to and subscribed before me this �9, day of � � ,�UI`� .—bY__, � � 1��G� %��il , w is personall nown/has Signature of property owner (individual or authorized representative of corporation, partnership or other entity) Signature of co-property owner produced Notary public, My commission expires: as identification. �N�IMII � �; � ''��, REBECCA LE77 ADAMS _, �: Notary Pubtic - State of Flarida ;� • f; My Comm. Expires Jan 4, 2p16 ''•;�'aF� �.•` Commission �Y EE 157150 ��"�� iAroupA Nalional Notary Assn. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 7 of 7 Revised 03/13 ��` rV �'.', • 1+' ' � ' ' . ' ' � 1 � . . . , � , ; •, , i� 1 . �,�..,.. ..�,. • • ' C � ,`�.�^�� • �r._% . .",, .. PINEl.lA6 COUNTY FLA:' �'.: i�s OF�'IQIAL .� ��' • ��•;; • INST �� 89-3113b5 BQp�(' �13� . rwq� p�_ � � �FdMI � � . RwMCO I011M � , • . . ; ' — �-� „� �;_. . _ _ . . . . _ ;�. �. ' '��.��,�.: � �_� a -�� rr .._. « , . � . , , . , w�,�.� �Wi•� �� E��.d itii. 12th aay el DeC��bet . A. D. 10 ,1�'.- --�--.',-- -�to�6tSODY' 8 TADefiNACLB, INC. " f�'d M�, b • � • ' " • + Oti• C, Green and snrb�r� C. Green, hi• •it� _ r��k"�4 1101 reirDurn Avenue� Cle�r�eler. llorid� ]�615 - � ..o�d p�rq � . . Iwv..r .w Mw�. s. � rrr�� -.d ••w.-.r wr!• �1.«d.r�� ii �MM+ wl w�4� d rWW.4, �.� w w.�..�� rN � ��Y w w��l . � �� Ti.e1 �ti� �.�d (I..i pory, jo► em� �n �v.v�d«r�bn �( �1M �aw d� 10.00 .. I , �e`I�wd rsd bs t1�...L! ..eoed var+�. �R..+�.�n� ��I�.,.e( V►....6� �cL+�o�vl.dv�L d.. h.J.� �wwl..�-n• �Mw a�i Qulis�id� wb �1�� ekl i.rond v�o�r� jorr��.. all 11u r1o�1. llt�. Iwtwwl. oi�dM ww� �� o�� . o d 11N wfd Ilal oartr Iw �n ond ro �A. lolbwlno �l.�twl�wl b�. v��n v virc�l ol 1�nd. �h�iir.:sMO � 6��0 1w tiu C.a�� o( Pinellae Si,�. o( Florid� , �e--..hh� P.! � . .. 111 --- R: . . . ..� �v . - ---- mY,":� • N4� � ,� �� i Lot One (1) in Block K� of Prookl�vn 3ubdivieion; eccocdinR t0 the Map or Plet thereof •� retorded in �let EoOk 013, Pege p59 of che puDlit �ecord• o! Plnellae CoUnty, Florfda. ' . ,f .� . �. i`� � � �r '' � -�;: � 7;: � 14U'�d5� GI:N 11-1 �-t3Y 1 b: !!: . . ' U1 ' HL•�ONUlt�ki 1 ib. ' Uu !; � fW�•5 2 ►U. � . . _... - IUTAL: ib. DOCY�Mf�lny f' ' ) � � 7 . - -. . . b�� • � �iQ.Y� i� �_ � . . . ` { ��. all� K�rl n ., • Uy_.._ - -. �.r�.. .�u� . �� Ifii�� W■WIJ1 I��e ��n�� IuNeil��r u�llti o�� ond �lnp4�Ar 1�1 aPW��1�,YM I�SOnEO lwlonarno o. �n o��Wu. app�wlo/nl�p. nnd pll �1,� ..►p�.. �to6�, ud�. t�i«w�. !�„ .q�ti o.d e��w w►�at- � �o�tyr a� Iti• �ol� flnl poNy, �Iltinr in �a�o o. Muil�. 1�� IR. 0��1 PAW► �. �+�fl ��»�no� o� I�a wdd �«-ond va�r 1�•�••. � i . ''• �I� iV►i�Ka.7 W�1� T1�r ro1�1 J�r�� perly ��e� ��CiiYJd�%� ` s�N��1��/J-�-� �Inl obow u.rlll�n. , �—� }� $ 7 pn e� ��o �� en d a� �l��er e d in p•r vnrr u�: � p n�a ;'A� / � `""'�-�.� , A , , (A. • I 1 .-� .!�/�!��-' .............. ........................ . ... . � � .. . � ........ � . . ._.... . . .. ..........................'---........�..................... ,....-'-•'--'-- ........... •'---'------...'-•._......_ ...............'---..__�.�� TATt OP PlAFt1 COUNTY �f �� n�� } ' _ • i, H 6AE�Y Ci1TlfY Arc��il� _ �r��!d officer dui w�6w�a�d �n �he Btale foR�.id ■nd �n �Ar CA..nt� �loenald m o►c �� p��„�ps�rb� �Y�/h►,�" s. ��Vi � � , . .. r, ',. S � .e.�s;.� �.�,,,,_..... • � . b me ino+n lo � I�t panon drKF+Md in and w�e ♦f�rvleA �jy Iwewol4� ml!lLRXLI tAd�.�� •. � bcipe me th�� { ![(CYlft� �hr umr. • �, Q�� +'ITVegg mv 6and �nd allirul �val in +1,� Coumv and I t �t IN� �(o�r++ lA � J,'�� oi ' Q C 4 rr.� �Jk A. D. 19 �� t��l��' >T �C�J I �J. y,,. , , r , :i r'�".� . l� :y � .�, �. � . ��.�� .-•y .J �� 1, . �' . ;',:' � ,. :�� ': v r � 0 ' �215 UNION ST ANX2014-09016 � 1 o (� Idlewild - Multiple Properties , ;� Zoning: Atlas #: 251 B - `�../�..r �..i v � 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 D�PARTMENT 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 T� 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 UPUN 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 COMPIY WITH ALL APPLICABLE REQUIREMENTS OF THE COMMUNITY DEVELOPMENT CODE. APPLICATION FEE: $0 IMPACT FEE/ASSESSMENT FEE: TBD information on Impact Fees orAssessment Fees is availab/e from the City of ClearwaterEngineering Department (562-4747). PROPERTY OWNER (PER DEED): Enrique Venegas MAILiNG ADDRESS: 1244 Palm Street, Clearwater, FL 33755-1129 PHONE NUMBER: 727-259-5001 EMAII: evenegas@tampabay.rr.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 1244 Palm Street, Clearwater, FL 33755-1129 PROPERTY: PARCEL NUMBER(5): 03/29/15/15840/001/0280 LEGAL DESCRIPTION: Cieardun, Block A, Lot 28 CURRENT CITY SERVICES: REQUESTED CJTV SERVICES: X (select all that apply) SANITARY SEWER SANITARY SEWER SOLID WASTE X WATER SOLID WASTE Planning & Development Department, 100 S. Myrtle Avenue, Ciearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 1 of 7 Revised 03113 n � � earwater � Planning & Development Department Petition for Annexation Data Sheet PLEASE ENSURE THAT THE FOLLOWING INFORMATION IS FILLED QUT, IN ITS ENTIRETY. FAILURE TO COMPLETE THIS FORM WILL RESULT IN YOUR APPLICATION BEING FOUND INCOMPLETE AND POSSIBLY DEFERRED UNTII THE FOLLOWtNG APPLICATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY): Residential Urban (RU) REQUESTED (CITYj: Residential Urban (RU) ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): SITE AREA: 0.14 SIZE OF DEVELOPMENT : Existing: 1 Unit Proposed: 1 Unit (e. g., number of units, hotel rooms or non- residentia! square footage) R-4, One, Two, and Three Family Residential Low Medium Density Residential (IMDR} acres USE OF PROPERTY: Existing (currently on site); Proposed (new use, if any; plus existing if to remain): If residential use, is unit(s) .,.., � � � 2� �.d� : Single Family Home Single Family Home No 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 � 3 day of /'� �Ji1U Zp � �' . by / I Signature er or representative Signature of property owner or representative � �?iG-t� ma�-�„r �`-1`t�°C'= who is personally known/has � produced � t� V 5 2ZZr ?�` �� ° as identification. Nota My commission expires: Notary PuWic Stete of Florida My Commisaan FF 046309 Expires 10115f2017 Planning 8, Development Department, 100 S, Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-362-4865 Page 2 of 7 Revised 03113 � 0 LL ° � earwater U PROPERTY OWNER (PER DEEDi: MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: Planning & Development Department Petition for Annexation Disclosure Statement Enrique Venegas 1244 Palm Street, Clearwater, FL 33755-1129 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 I5: PARTIES INVOLVED — NAME: NAME: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? PARTIES INVOLVED — NAME: NAME: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? PARTIES INVOLVED — NAME: NAME: YES PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: NO m NO 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 � 3 day of �cJ�� . "Z.o i `( . bv Signat � � owner or representative Signature of property owner or representative �N�2�� m��i� ��N�3� , who is personally known/has produced �� LL �' S2Z 7-r� �� as identification. a�blic, commission expires: �i Notary Public State of Florida My Commission rr Expires 10/15I2017 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 � ° � earwater Planning & Development Department Petitian for Annexation � Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed — PRINT full names: Enrique Venegas 2. That (I am/we are) the owner(s) and record titie holder(s) of the following described property: 3. That this property constitutes the property for which a request for (describe request): 4. That the undersigned (has/have) appointed and (does/do) appoint: as (his/their} agent(s) to execute any petitions or other documents necessary to affect such petition; 5. That this affidavit has been executed to induce the City of Clearwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by City representatives in order to process this application and the owner authorizes City representatives to visit and photograph the property described in this appiication; 7. That (I/we), the undersigned authority, hereby certify that the foregoing is true and correct. THIS Property Owner Property Owner STATE OF FLORIDA, COUNTY OF PINELLAS Property Owner Property Owner BEFORE ME THE UNDERSIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON DAY OF PERSONALLY APPEARED WHO HAV(NG BEEN FIRST DULY SWORN DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFfDAVIT THAT HEJSHE SIGNED. Notary Seal/Stamp Notary Public Signature My Commission Expires: Planning & Development Department, 10Q 5. Myrtle Avenue, Ctearwater, FL 33756, 7ei; 727-562-4567; Fax: 727-562-d865 Page 6 of 7 Revised 03/13 � 1 ° � ear�at�r U PROPERTY OWNER {PER DEED): Enrique Venegas Planning & Development Departtnent Petition for Anne�ation Supplemental Statement MAILING ADDRESS: 1244 Palm Street, Ciearwater, FL 33755-1129 CITY OF CLEARWATER CASE NUMBER: I/we, Enrique Venegas [insert names of all property owners), havin� filed a Petition for Annexation re�ardin� 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 Ctin�lorpgnt�+�±crr�cnf �h�ll g��nn��o�10 �nv nrnvicinn in anv Aarcomont tn Annuv cvoriitar� hv rrio/iic nr m�il�i�r `.._� . ... r•_ � r„� ............ ... .....� . .o........_... _........,... `..._,..____ ..,� ...,., _... ... ...�i predecessors in interest. I/we further agree and acknowledge that I/we shall not rescind the Petition for Annexation or execute any dacuments attempting such rescission, and that any attempted rescission shall be of no force and effect. 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 day of produced Signature of property owner (individual or authorized 1 G�.I12JC1 ila' LIYC u� C.ui Nvi ativi i� prniii �ci Siiia vi vii ic7 entity) Notary public, My commission expires: Signature of co-property owner . by who is personally knownJhas as identification. Planning & bevelopment Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, TeL• T27-562-4567; Fax: 727-562-d865 Page 7 of 7 Revised 03113 I#: 2006118729 BK: 15024 PG: 452, $10.00 D DOC STAMP COLLECTION $749 COUNTY, FL BY DEPUTY CLERK: CLKDU08 03/31/2006 at 10:27 AM, RECORDING 1 PAGES .70 KEN BURKE, CI.ERK OF COURT PINELI�AS FLORIDA WARRANTY DEED Prepared By and Return To: ,", WPI Title Direct, 111 Founders Plaza, E. Hartford. CT 06108 `� �� Property Appraiser's Parcel I.D. Number: 032915158400010280 '� \ -�� ,�> This Warranty Deed made this 16'" day of December, 2005 by and between Dale Richard and �; ` Karen Richard, husband and wife hereinafter called the Grantor, whose mailing address is �� 10204 Hudson Ave., Hudson, FL 34669; and Enrique Venegas, unmarried, hereinafter called the Grantee, whose mailing address is 1244 Palm St., Clearwater, FL 33755 -- WITNESSETH, that the Grantor, for and in consideration of the sum of One Dollar ($1.00) and ;; �, �, �� other valuabie consideration, the receipt whereof is hereby acknowledged, hereby grants, �' '� bargains, and selis unto the Grantee, and Grantee's successors, heirs, and assigns forever, all -� �� , . , .. that certain parcel of land in the County of Pinellas, State of Florida, to wit: ,�, -�� -- Lot 28, Block A, Cleardun Subdivision, according to the plat thereof, as recorded in Plat Book �� , 13, Page 47, of the Public Records of Pinellas County, Florida. '` '' �, TOGETHER with all of the tenements, hereditaments and appurtenances thereto belonging or �� -- in anywise appertaining. - -' TO HAVE AND TO HOLD, the same in fee simple forever. AND the Grantor hereby covenants with the Grantee that the Grantor is lawfully seiz�c7.of sai�,> land in fee simple; that the Grantor has good right and lawful authority tos lI'ar�l conVe�y thiS, � land; that the Grantor hereby fully warrants the title to the land and wili de��qd'tp� Sari�e'agSinst the lawful claims of all persons whomsoever; and that the land is frag of all`�hcufqb�an��, except taxes accruing subsequent to December 31, 2005 and rest�icttqns, coverfants, and easements of record. � ` __ , � IN WITNESS W HEREOF, the Grantor has signed and sealeci"these pres�ls tRe day and ar / , , , � first above written. , , � �� . „ „ Signed, sealed and delivered in the presence of: �, , G�!l� vy �PCC 4is��t�re ' �v'antor Sionature � Tcx�ya�l��a��.er►7�';� ' � `spA[._�. ��..�,A1'1-1� Printed Name Printed Name , - - , �" ��2--!'/Y% ��%�- Witness Si�nature � � Grantor Signatu e, REBECCAMROZINSKI `� � \�� Q�"i(/ �i�� PritYied Marlae ; ; Printed Name STATE O� EL IDP; � G�QCINTY OF � ��.�2��QS The hueg,oin ir�trument was acknow�edged before me this � day of � , ��by � l� �;�� :.�.�d �- � v� Q��L.[��, who are (is) personally known to me or who have (has) produced E L � L- as identification and who did (did not) take an oath. (Notarial Seal) � �TONYA R NORTHERN • ••• �,,,�„� Doaoc»e � °'' »"'� � �„� ,. . i � uwleooH�-�2sc: = y'a^� �Hwry�aen.��c ' i ....................... ...... �l ��Z _ _- Notary Public �� T�Y�11C� ll`1 `t'V�Y"�. :.�.. .��• •�». nnted me �� 6 '� Ct190f000 : .,,� My Commission Number. : Na3 a vxr+oi ;......... ..... .......... My Commission Expires: �