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ANX2015-02005. , LL . ° ��t�� U 1268 SEDEEVA CIR ANX2015-02005 The Sedeeva Cir N 1 Land Trust UTD Zoning: Low Medium Density Re Atlas #: 251 B Planning & Develapnaent Depar#ment Pet�tion for Annexativn ALL APPLICATIfJNS ARE i'� BE FllLED UUT COMPI.ETELX Afi1D COltRECTLY, ANp SUBM�TTED IM FEii'SOM (NU FA% Oit DEUV€RlES) T� 7Hf PiANN�NG & DEVELOPMENT DEPARTM�NT BY NCN3N flN tNE SGMEDi)i.ED DEADLlNE DATE. A TOiA1 OF 8 COMPLETE SECS OF APPUCATi+DN ANA SUPPLfMENTAL MAT'�R1ALS {1 pFtIGINAI AND 5 Ct?PIES) AS REQUtRED WITHiN ARE Tfl BE SUBMITfED FOR itEV1E1N SY TNf DEVELOPMENT REViEW CUMMft'TEE. APPUCATIONS AND SUPPL�MENTA! MA'iEf�tALS AftE REQVIR€d 1'Q BE COUAiED AND STAP�.ED lNTQ S�T�, !T IS INCUMBENT UP'ON THE At�PLICANT TtJ SttBMIT CAMPL�T'E AND CflRREGT iNFORMATION. ANY MISLfADIN6, DECEPTiVE, iNGOMPLE3E OR INtORRfCT iN�ORMATiUl1i MAY IAIVALlDATE YUUR APPLICATI�N. �tlf APPiiCANT, BY �ILING TMIS APPUCATiQN, AGi2EES TO COMPLY WITH AtL AFPUi;ABLE REQ111REMEN�'5 OF TNE COMMUNiTY DEYEL�PMEiVT CODE. APPLICATIOIV FEE: lMPACT FEEJASSESSMENT FEE: PR{3PERTY OiNIVER (PER DEEDj: MAILlNG ADORESS: PHO1dE NUMBER: EMAIL: AGEW7` OR REPRESENTATtVE: MAlLlNG AC�DRESS: PHCI�IE hiUMBER: f1V1AlL: ADDRE55 �F St1BJ��7' PROPERTY: �q 1'BD lnformation on Jmpact Fees orAssessment Fees is available f,+r3m the City of Clearwater Engineering �epartment (562-4747), The Sedeeva Cir N 1 Land 7rust UTD PO Sox 542, �unedin, fL 34697 727-733-7574 1268 Sedeeva Cirde Notth PARCEL IUUMBER�S}: 03-29-15-28498-0t30-007fl tEGAI. QESCRIPTION: Floradel Subdivision Lot 7 CURRE11t7 CITY SERYICES: liFQUESTfU ClTY S,ERVlCES: x {seleci all that apply) SANtTARY SEWER �AtVfTARY 5EWER SQLIfl WASTE x x S�UD WASTE WATER Planr�ing 8� psv�tupment Departrnent, i0Q 5. il�yrtle Avsr�ue, Cteamaiar, FL 33756, Tel: 727-582-4587; Fax: 737-562-4855 Page 1 of 7 Rsvised U1l15 � � Planning & Deve�apment Department � � ��,�� Petition for Annexation U ` Data Sh+eet PLEAS� ENSURE THAT '�l�iE FQLIDWiNf INFORMATIUN i5 FILLEd UiJT, IN �TS ENTiRETf. FAtIUR� T� COMPLEfiE THfS F{}RM WIU. RESUIT !N Y`OUR APPL1GATt�N BE1NG FOUN� INCOMPLETE AND POSSIBIY DE�ERRED UN�1L TH£ FflLLOW1NG AAPLiC;ATiON CYCLE. FUTURE lAND USE PLAN O�S{6NATIDN PRESENT {C011NTY}: Residential Urban {RU) REQUES'i'ED (ClTY}c Residential lJrban {RU} ZONING DISTRiCT PRESEIVT (GOUNTY): R-4, One, Two, and Three Family Residential REQUESTED tCiTY): �.�v++ Medium Density Residential (LMQEt) 51TE ARfA: U.155 SiZE O� DEVEtOPMENT : Existing: 1 Praposed: � (e_g_, number of units, hote! roorrrs ar nom residential square footage) acres USE OF PRt}PERTY: Existing {currentiy on site): Single Family Propose�l (new use, if any; plus existing if to remainj: If residential use, is unit{s} rerttal? Single Family STATE OF FLORtDA, C�UNTY Of PiNELLAS I{we}, the undersigned, acknowledge thai a!1 representations made in this appfication are true and accurate to the besc of my knowledge and authorize City representatives to visit and photograph the property described in this appli ion. � Swarn to anti subscribed before m� this � �—.-_ day of _� t-, a : sL- �- �Y J'`�'�g`'1 ��' %� � who is personaliy known/has �� .� �,,�,,.� praduced as:dentifscatic�n. owner or represe�tative �� . Notary pubiic, Sign�ture of property owner or regresentative •.•� �• EXPIRES: August 35, 20ie ndoc Thtu N�ry wbSc thx�erw�itsrs Planning & Develnpment Departmerat, i0ii S. Myrtie Avenue, Cle-an�vater, FL 33756, 7ei: 727-5S2-d567; �ax: 727�62-48�&b Page 2 of 7 Rsvised 011'!� c,y,.. f �/� � o . , �� Planning & Develc�prnen►t Department Petition for Annexation `� Submittal Package Tnstructions & Ch�cklist 1N ADDITIflN TfJ THE COMFiETED AIVNFXATION P€TtTIC3N FORM, ALL PETlTlON �dR ANNEXATiON PACKAGES StfAil liVCtliD� A SUBMlTTA� PACKAGE THAT INCLUDES THE FOLLt7WiNG: p Signed and swom (n4tarized� disclosure c�f interest statement (form attached�. p if the pro�erty is not a pfatted lot of record, a current survey identifying the dimensians, area and #ocatfon of the property having been prepared, signed and sealed by a iand surveyor currently registered in the 5ta#e of Florida within the mcsst recent 32 months. [Note: Submit two copi�s onJy] ❑ If deveiopment is to be initi�ted prior to submissian of an annexation petition and/or prior to the effective date ofi the annexation, r�quisite site plans, plat, and engineering plans. C� Terrns of a proposed Agreement to Annex, if any. L7 ❑ � � If the proposed annexation requires a change in the land use dassification and zoning categrary assigned to the pr�perty, a justification #or such change must k7e submitted in writing. l# the requested zoning is not consistent with the futur� Land Use Map o# the City af Clearwater Comprehensive Plan, the applicant will be required to #ile a companion application ta amend the map. Proaf of ownership (e.g., copy of deed, title insurance policy, or other ins#rument demonstrating ownership}, [Note: Sulrmit twa copies onty] 1# connection to city services is desired prior to the effective date of the annexatian, applicant must provide notarized Petitic�n for Annexation Supplementat Statement (form attached). [Nate: Submit originol only] 1f applican# is designat'sng an agentJrepresentat'sve to work with City, applicant musi provide notarized Affidavit to Authorize Agentf Representative �form attached}. (Note: Subm+t originol only] IIVFQRMAT101Y REQUtRfD TO COMPLEfE iNE PETITION FOft ANN�XATION APPU{:ATft7N AND UATA SIiEEI' �AN BE FOUt�JD UN 7HE FOLIfJWiMG DUCU(VIEMi5 ANDI�7R OA1U111E AT 7HE FOLLOWING WEBSITES. IF i'HE APPl.!{:ANT 15 UMCER7AiN WtiERE TO LDCATE THI� tNFQRMATIC?N Oii NEEDS ADD1TlONAL ASSISTANCE, PLEASE �ONTACT THE PLAN1111NG Ai�iD LiEVELOPfVlENT DEPART11IfENT, lON6 RANGE PLANNING DIVI510111 AT 727-562-45b7. ❑ PARCEi� NUMSER (Parcel I.D. Number) can be found on the Warranty Deed. It can aiso be found by searching the PineNas County Property Appraiser's 4ffice website at www.pcpao.org (search database by address). 0 LEGAL DESGRIPTION can be found on the Warranty Deed. tt can also be found by viewing the property recarc3 online �t the Pinellas Gounty Property Appraiser's S�ffice website ai www.pcpao.org. ��UTURE LAND USE PlAN �ESIGNATION (CC3UNTY) can be found by viewing a Property Fteport using Pinellas County's Pubtic �is V+ewer ava"slable online at http: j is.pineliascountv.or�Jpublic �is/. Search by property address or Parcel LD. Number and repvrt �ri!{ appear. 0 FIJTURE 11#ND USE PLAN DEStGfVATlON {CITY) is typically the same as the land use des'sgnatian in Pineilas County, unless applicant is proposing a change (see submitta! package requirements for more information}. ❑ ZQNlNG DI5?RICT (Ct?UN7Y) can t�e fiound by viewing a Property Report vsing Pinellas Cour�'ty's Pubiie G1S Viewer availabfe online at http://�is,pineliascqunty.org/pubiic�isJ• 0 ZONING �(STRICT {CIiY) can t�e fou�d by contacting the Pianning and Development Departm�nt or viewing #he City's Zoning Atlas, available oniine a# httu'//www mvclQarwater.com/�avldeptsJpwa/en�in/publicationsJengatlaslatlas.asp. ❑ SITE AREA (ACRES) can be found by viewing a Pfoperty Report using Pineltas County's Public GlS Viewer auai9able online at http•/J�is pineilascountv ar�/public �isJ. Planning & i)evetopment Departmeni, 100 S_ Myrtle Avenue, Clearwater, FL 3375&, Tel: 727-562-4567; Fax: 727-562-�865 Page 3 of T Revised 07f15 C: ° ��r � �� U AiTEtUDAN+CE AT PI�BUC NEARENGS Planning & Development Department Petition far Annexation Infa�na�fln for Appli+canis The applicant or appiicant's representative is encouraged to attend City Council �ubiic hearings unless the annexation pertains to a property developed or to be developed wittt one single family dwelling. STANDARDS FOi2 AiNNEXA7i0AF In determining whether to annex a property, the City shall consider the extent to wh+ch: D The propose�! annexation wili impact public services (e.g., water, sewer, police, parks, etc.). ❑ The proposed annexa#ion is consistent with the City of Clearwrater Compreh�nsive Ptan. CI The propased annexation requires a change in the future land use and zoning dassifications assigned #o the property as weil as the jurisd"sction far said change. 0 Existing Qr propased development is consistent with Ci#y regulations. D Terms of a proposed Annexation Agreement, if any, promotes the City of Clearwater Comprehensive Plan. PROPERTY OWNER AG#tEfME1�i3' P{ease be advised i#�at, in cansideration af the annexation, the property owners do hereby agr�e that_ C7 Ali structures and improvements which are erectecf upon said property subsequent to the datE of this petition #or annexation shall comply with ai! applicable City of Clearwater regalations and ordinances as set forth in the City Code of Ordinantes; C:7 AI! resid�ntial retttal uttits, including single-family residences must comply with the requirements in the city's residential rental ordinance, which requires ihe property owner to obtain a Business Tax Rece+pt upon annexation into the city; 0 i# development is to be ittitiated priar to submission of an annexation petition andJor prior to the effective date af the annexation, requisi#e site p{ans, plat, and engineering pEans shali be submil-ted ta ensure compliance with the city's CommuniLy Development Code (see Submittai Package Instructions Checklist). It is recommended that the applicant meet with Planning and Develo}�rnent Department staff to review plans andJor discuss the appli�able city regulatians; ❑ A11 annexations of residential dwellings o# eight dwelling units or more shai! convey sucn recreation facilities fees and r2creation land dedication andJor fees in the amount and manner prescribed by Chapter 54, Article II of ClearwaLer Code of Ordinances; and J When any substandard abutting street or utilities are subsequently upgraded by the City to meet City Standards, said improvement{s� wili be done on an assessment t�asis, consistent with Gity procedur�s therefare. Planning & Deve{apment [3epartment, 100 S. Myrtie Avenue, Ciearwate�, FL 33?55, Tei: 727-552-45&7; �ax: 727-562-486b Page 4 of 7 Revised Q1t1� 0 G � � �� . �.�� r � ��a t} PROPERTY CtWNER (PER dfED}: MAlLING ADDRESS: PH�NE �IUMBER: EIv1AiL; AGENi' {.�R R�PR£SENTATIVE: MAiL1�iC AD[3RE55: PHONE NUMBER: EMAIL: Planning & Development l)epartment Petition for Annexa�ion Disclasure Statement The Sedeeva Cir N 1 Land Trust UTD PO Box 542, Dunedin, Fl 3�4697 727-�33-7574 OTHER P�RSO�iS IiAVING ANY OWNERSHlF 1NTEREST tN 7HE NAME: ,�Ir INTEREST 1S: SPECtFK lNTEREST HELt3: DOES A CONTRAC7 EXt5T FOR SALE OF CONTRACT IS: PARTiES INVOLVED- IVAME: NAM E: PROPERTX? ARf THERE ANY t7PTfONS TO FURCHASE THE SU81E�7 PROPERTY? PARiifS iNVOLVF€3 - IVAME: NAME: ARE THERE AldY MflRTGAGES Oft UENS ON THE SLjS1ECT PRpP£R71f? PARTiES 3NVOLVED - NAME: NAME: PROPERTY: YES PHONE TUUMBER: PHONE IVUMSER: YES ��o�i� r�unna��: PiiONE NUMBER: YES PHQNE NUMBER: � PH�fUE NllMBER: NO � rvo ' STA'CE OF FtORiUA, cou�rr o� ��uAs i(we}, tfie undersigned, acknowiedge tfaat a!! representations made in this appiication are true and accurate #o the best af rny knowledge and authorize Ci'ty representatives To visit and photograph the property described in this application. Sworn tr� and subscribed before me this f`'� �- day of ��-,��= �..v1S .ay owner or Signature of property owner or representative who is personaliy knownJhas praduced as sdentification. Notary pu Planning 8 Developmeni Department, �00 S. Myrtle Avenue, Clearvrat�r, F� 337fifi, Tel: Page 5 of ? AIY CUA�+MSSION � �F 131-Pa f;. EXP�flES; August t5, 201� ; x . .�ler5 �•� R -582-4SS7; Fax: 72�b'�-4885 Revised OitZS LL ° ��r��a%r �� U Planning & Development Department Peiition for Annexation Af�davit to Authorize 1. Provide names of al{ property owners on deed - PRI1�T fuil names: The Sedeeva Cir �I 1 Land Trust UTD 2, That (1 amJwe are} the owner{sj and record titie halder(s) of the following described prc�perty: 1Z6$ 5edeeva Circie N, C4earwater, Fi 33755 That this property constitutes the praperty for which a request far (describe requesij: Annexation in order to receive solid waste and sanitary sewer service from the G#y. 4. Thatthe undersigned (has/have} appointed and (doesJdo} appoint: `��-�---�-�,�.c��a as (hisJtheir�"agent(sj to any petitions or other �iacumerits necessar}r to affect such petition; tative 5. ihat this affidavit has been �xecu'ted to induce the City of Clearwater, Florida tc� consider and act on the above described properly; 6. That site visits to the propertY are nec�ssary by City representa#ives in order to process this application and the owner autharizes City repres�ntatives to visit and photograph the praperty described in this application; ,7. Thai (,{/we}; the undersigned authority, hereby certify that the foregoing is true and corred. The Sedeeva Cir N 1 Land Trust UTD Property Owner "Y- /l,.-✓ ( — Property C3wner Si'ATE {)F FLORIDA, CtJUNTY OF P1111ELiA5 8£FORE ME THE UN{7ER5lC�NED, AN TNIS ��_ �AY fl� � � �7�-�-�s �)�- , i.�'� Property fJwner Property �wner DULY CQMMfS�IONED BY THE LAWS {�F THE STATE OF FLORipA, ON �^�� DEPOSEfl Ai�D SAYS THAT FiE/SNE �UILY UNt3ERSTAPiDS THf Notary SeaiJStamp My C�mmission � � � � , PERS�NALLY APi'EAEtED WHO HAVIIUG BEEN FIRSf DULY SWt�RN (�F THE AFFIDAVIT THAT HE/SHE SIGNED. Signature 71uu Naary Putilic Undenuitets Plannirx� R Develvprnent Depar#ment, 1t� S_ Myr#le Avenue, Ciea+water, FL 337fi6, Tel: 727-562-�567; Fax: 7?7-552-4865 Page S of 7 Revis�d fl1115 , , , , ��. � . o ,^, �� PROPERIY 4WNER (i'ER DEED)s The Sedeeva Cir N 2 I.and Trust UTD MAILIN6 ADDRESS: PO Box 542, Dunedin, FL 34697 CITY (�F CLEARWATER CAS€ NUMBER: Fianning & Deveivpment Departrnent Petiti4n for Annexation Statement iiwe, _The Sedeeva Cir M 1 Land Trust UTD [inserr names af al4 property owners], having filed a Peti#ion for Annexation regarding the above property/case number, grant consent, agree and acknowledge that the City of Glearwater may immediately or at a later time process the application to completion, including adoption and recordation vf related Ordinances, without the necessity to further natice meJus. This Supplemental Statement shall supersede any prov�sion in any Agreement to Annex executed by melus ar my/aur predecessors in interest. IJwe further agree and acknowledge that I/we shail nat rescind the Petition for Annexation or execute any docurnents attempting such rescission, and that any attempted rescission shali be of no force and effect. STATE OF FLt3RIDA, COUNTY �F PINELLAS I{v,re), the undersignesi, acknowledge that all represeniations made in this applicaiion are true and accurate to ihe best of my knowl�dge and authorize City represQntatives to visit and photograph #he property described in this application. Sworn and subscribed befiore me this i� c�ay oi J c'Y �.4 t � . by �•'�`i,�/ � ��'�- - y.a ��i�-� .��'`�hnrho is personakly knownJhas 7 � j � � -.�- t��„-�_�c�.�.,,,,,,/ roduced _� as identification. � property owner �ind►vlduat t�r autnori� ve of corporation, partnership or ather commission Signature ot co-p�operty awner , •, .. EXPtRES: Augu� 1� �ys s�a n� ►+�r � ��=;. Piannang 8� l�evelopment Uepanment, 1 QO S. Niyrtie Avenue, Clearwater, Ft 3375fi, Tel: 727-562�i567; Fax: 727�62-4865 Page T af 7 Revised 0�1l1b I#: 2005128585 BK: 14228 PG: 229, 04/07/2005 at 09:53 AM, RECORDING 2 PAGES $18.50 D DOC STAMP COLLECTION $560.00 KEN BURKE, CLERK OF COURT PINELLAS COUNTY, FL BY DEPUTY CLERK: CLKDM03 Republic Land aud Title, Inc. 4175 Woodlands Parkway Palm Harbor, FL. 34685 File Number: OS-0241 OR ,, ,, ,, ,, __ � _____�� ', ', ' ,� Warranty Deed - - � ,, _ _ , ,� Made this April S, 2005 A.D. By Marla J. Lyon, a single w�omxn, whose address is: 137 Douglas Ave, Dunedin, FL 34698, hereinafter catled the grantor, to Ric6ard Davis, whose posi office address is: 1265 Sedecva Circle North, Clear,watei, �'�loYida 33�?3, hereinafter called the grantx: � - - - ,, �� ..� � � � , (Wheaeva uud haein the term "gantor" and "�anlx" mclude all t6e pffities to this instrume�t aod the hein,lFg�1 repreuat�ti�e and assigia of individuals, aod ffie succes.wrs and auigns of coipaatioas) '� Witnesseth, that thc �antor, for and in considcration of the sum of Ten Dpllars, ($10.00) and other valuable consiclerations, receipt whereof is hereby aclmowledged, hereby grants, bargains, sells, aliens, remise`s,ir�lcases, conveys and confinns unto the grantee, all that certain land situate in Pinellas County, Florida, viz: ��> �"�� ,,_ Lot 7, FLORADEL SUBDMSION, according to the map or plat ther�Jf, a�recordet�' in Plat Book I S, Page 7, Public Records of Pinellas County, Florida. ``.' ' , ,� , -- � . ,' " �� , ,' ' � Parcel ID Number: 03l29/15/28098/OOU/0070 �, ', �, ', � � �, Together wich ail the cenemencs, herediqmants and,agpu?benances theceW belonging or in anywise appertaining. To Have and to Hold, the sam,e�iri fF��}p(e foreve3�� And the �rantor henby cove�a�fts wiilS,9aid grantee that the grantor is lawfully seized of said land in fee sicnple; that the grantor has good right and lawfW authority to selt am3 convey said land; that the granWr hereby fully warranb tLe title to said land and will defend the same agaiast the Iawful clajm's_n�'al� }ie,rsons whomsoever; and that said land is free of alt encumbrances w�cept taxes accruing subsequent to December 31, 2(�t'. „ � � �� ,� � �. „ _ , �� . �� , �, „ DEED Individual Wazranty Deed - l.egal on Face Closas' Choicc PINELTJAS CUUNTY FL OFF. REC. BK 14228 PG 230 Republic Land and Tide, Inc. 4175 Woodlands Parkway Palm Harbor, FI.. 34685 File Number. OS-0241 OR - "� � �, ,, __ �, _ _-_�, -�� > ,� - -- , ,' , < < �� ' ,, � � �, „ --_, , `. , � In Witness Whereof, the said g�avtor has si�ed and sealed these prtsents the day acid'year first �briyGVr'ritten, � � ., �� " S�gned, sealed and delivered in our presence: '. �� 1; ,, i �.l P�� - - - �g�� Poulo Migliorini Marls J. Lyon '. ,� wimcss ' ted Name Addrcss: 13�.Dougla3.t�ve, Dufiediu, FL 34698 ,,�� , „ ' , ,, _ . . � (Seal) �� /L�„ a r d C�-t �" �-�- , - - , ' �' � � , �,� �� ,'; -�:'.' � �, , , �> , , ; �, � State of Florida � � � � , ,, County of Pinellas - � The foregoing instrument was aclmowledged lfefoFe y�e,fhis Ap� 5, 2005, by Mazla J. Lyon, a singk woman, who is/are personaily lmown to me or who has produced Dtivers I�oenst(sr�s identificadon. , - - ` Not�ry b �� Mt�,.�i�i�ii� � � - - Print 4/ � �� .. � � �� _. ' `� . ;� �� i ., DEED lndividual Warranty Dced - L,egal on Facc Closcs' Choice My Commisabn E:pira: PsWa �MpMprNy �� MYCp�ionD021EW2 a� ExpiM S�plrnber 01 20p7 LL ° = � rwater }� 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 COILATED 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: $0 TBD Informafion on lmpact Fees orAssessment Fees is available from the City of Cleaiwater Engineering Department (562-4747). PROPERTY OWNER (PER DEED): Donald B. Lay MAILING ADDRESS: 1276 Sedeeva Circle North, Clearwater, FL 33755-1141 PHONE NUMBER: �) 2 �-�� y_ �� EMAIL ,� �;.� 1 � .� l� a-,f.,,,�ti�d AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBIECT 1276 Sedeeva Circle North, Clearwater, FL 33755-1141 PROPERTY: PARCEL NUMBER(S): 03-29-15-28098-000-0030 FLORADEL SUB W 10FT OF LOT 2 ALL OF LOT 3 LESS PART OF LOT 3 DESC BEG SW COR OF LOT 3 TH E lOFT TH N 46FT TH NW'LY 55FT TO A POINT 44FT S& 8FT E OF NW COR OF SD LOT 3 LEGAL DESCRIPTION: TH N 135FTT0 POB CURRENT CITYSERVICES: REQUESTED CITY SERVICES: x (select all that apply) SANITARY SEWER SANITARY SEWER SOLID WASTE x SOLID WASTE WATER Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 1 of 7 Revised 03/13 o Planning & Development Department � � �arwater Petition for Annexation � Data Sheet PLEASE ENSURE THAT THE FOLLOWING INFORMATION IS FILLED OUT, IN ITS ENTIRETY. FAILURE TO COMPLETE THIS FORM WILt RESULT IN YOUR APPLICATION BEING FOUND INCOMPLETE AND POSSIBLY DEFERRED UNTIL THE FOLLOWING APPUCATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY): Residential Urban (RU) REQUESTED (CITY): Residential Urban (RU) ZONING DISTRICT PRESENT (COUNTY): R-4, One, Two and Three Family Residentia) RE4UESTED (CITY): Low Medium Density Residential (LMDR) SITE AREA: 0.159 acres SIZE OF DEVELOPMENT : Existing: 1 Proposed: 1 (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) re�ia!? Single Family Dwelling Single Family Dwelling 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 J � u �-�( , Zors . by � � p�'�'4 g• l�� , who is personally known/has d'►,� , � � `- uce D!� Q.IVI.r�-S as identification. Signature of property owner or representative / � LEN� � My commission expires Signature of property owner or representative ROBER7A L. GIUSKI Nota�y Public - State ot Florida y omm. x � Commission � EE 9046T 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 LL o ter � � �arwa U Planning & Development Department Petition for Annexation Submittal Package Instructions & Checklist IN ADDITION TO THE COMPLETED ANNEXATION PETITION FORM, ALL PETITION FOR ANNEXATION PACKAGES SHALL INCLUDE A SUBMITTAL PACKAGE THAT INCLUDES THE FOLLOWING: 0 Signed and sworn (notarized) disclosure of interest statement (form attached). ❑ If the property is not a platted lot of record, a current survey identifying the dimensions, area and location of the property having been prepared, signed and sealed by a land surveyor currently registered in the State of Florida within the most recent 12 months. (Note: Submit two copies only] � If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plat, and engineering plans. ❑ Terms of a proposed Agreement to Annex, if any. 0 If the proposed annexation requires a change in the land use classification and zoning category assigned to the property, a justification for such change must be submitted in writing. If the requested zoning is not consistent with the Future Land Use Map of the City of Clearwater Comprehensive Plan, the applicant will be required to file a companion application to amend the map. ❑ Proof of ownership (e.g., copy of deed, title insurance policy, or other instrument demonstrating ownership). [Note: Submit two copies only] ❑ If connection to city services is desired prior to the effective date of the annexation, applicant must provide notarized Petition for Annexation Supplemental Statement (form attached). [Note: Submit origina! only] ❑ If applicant is designating an agent/representative to work with City, applicant must provide notarized Affidavit to Authorize Agent/Representative (form attached). [Note: Submit original onlyJ INFORMATION REqUIRED TO COMPLETE THE PETITION FOR ANNEXATION APPLtCATION AND DATA SHEET CAN BE FOUND ON THE FOLLOWING DOCUMENTS AND/OR ONLINE AT THE FOLLOWING WEBSITES. IF THE APPLICANT IS UNCERTAIN WHERE TO LOCATE THIS INFORMATION OR NEEDS ADDITIONAL ASSISTANCE, PLEASE CONTACT THE PLANNING AND DEVELOPMENT DEPARTMENT, LONG RANGE PLANNING DIVISION AT 727-562-4567. ❑ � ❑ ❑ ❑ 0 0 PARCEL NUMBER (Parcel I.D. Number} can be found on the Warranty Deed. It can also be found by searching the Pinellas County Property Appraiser's Office website at www.pcpao.or� (search database by address). LEGAL DESCRIPTION can be found on the Warranty Deed. It can also be found by viewing the property record online at the Pinellas County Property Appraiser's Office website at www.pcpao.or�. FUTURE LAND USE PLAN DESIGNATION (COUNTY) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://�is.pinellascountv.or�/public �is/. Search by property address or Parcel I.D. Number and report will appear. FUTURE LAND USE PLAN DESIGNATION (CITY) is typically the same as the land use designation in Pinellas County, unless applicant is proposing a change (see submittal package requirements for more information). ZONING DISTRICT (COUNTY) can be found by viewing a Property Report using Pinellas County's Pubtic GIS Viewer available online at http://�is.pinellascounty.or�/public �is/. ZONING DISTRICT (CITY) can be found by contacting the Planning and Development Department or viewing the City's Zoning Atlas, available online at http://www.myclearwater.com/�ov/depts/pwa/en�in/publications/en�atlas/atlas.asp. SITE AREA (ACRES) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://�is.pinellascounty.or�/public �is/. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 3 of 7 Revised 03/13 LL ° rwater ��a � ATTENDANCE AT PUBLIC HEARINGS Planning & Development Department Petition for Annexation Information for Applicants The applicant or applicanYs representative is encouraged to attend City Council public hearings unless the annexation pertains to a property developed or to be developed with one single family dwelling. STANDARDS FOR ANNEXATION In determining whether to annex a property, the City shatl consider the extent to which: ❑ The proposed annexation will impact public services (e.g., water, sewer, police, parks, etc.). ❑ The proposed annexation is consistent with the City of Clearwater Comprehensive Plan. ❑ The proposed annexation requires a change in the future land use and zoning classifications assigned to the property as well as the jurisdiction for said change. ❑ Existing or proposed development is consistent with City regulations. ❑ Terms of a proposed Annexation Agreement, if any, promotes the City of Clearwater Comprehensive Plan. PROPERTY OWNER AGREEMENT Please be advised that, in consideration of the annexation, the property owners do hereby agree that: ❑ All structures and improvements which are erected upon said property subsequent to the date of this petition for annexation shall comply with all applicable City of Clearwater regulations and ordinances as set forth in the City C�de of Ordinances; ❑ All residential rental units, including single-family residences must comply with the requirements in the city's residential rental ordinance, which requires the property owner to obtain a Business Tax Receipt upon annexation into the city; ❑ If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plat, and engineering plans shall be submitted to ensure compliance with the city's Community Development Code (see Submittal Package Instrudions Checklist). It is recommended that the applicant meet with Planning and Development Department staff to review plans and/or discuss the applicable city regulations; 0 All annexations of residential dwellings of eight dwelling units or more shall convey such recreation facilities fees and recreation land dedication and/or fees in the amount and manner prescribed by Chapter 54, Article II of Clearwater Code of Ordinances; and ❑ When any substandard abutting street or utilities are subsequently upgraded by the City to meet City Standards, said improvement(s) will be done on an assessment basis, consistent with City procedures therefore. Planning & Development Department, 100 S. Myrtle Avenue, Clearvvater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 4 of 7 Revised 03l13 LL ° � �„�rwater � U 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 Donald B. Lay 1276 Sedeeva Circle North, Clearwater, FL 33755-1141 OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT 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: 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: � 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 v�3 R-� day of � . i A-�-�il ��i . 20l S. by — �OIJ�'Ct�•1� g• 1.�� , who is personally known/has � 6�% - �/%/��— �uced �Q(1.1.0/� 1��1�� as identification. Signature of property owner or representative Signature of property owner or representative L.� Nc�i'j(!�'Gb�l(C, s'�'r P�y.,,, ROBERTA L. �LUSKI .� a� �; Notary Public - State of f1orlCa My commission expir ;.�•; Mr Comm. Exnires Mav 2Z 2ot Commission # EE 90467 Booded Thrwpl� National NotuY Aasn. 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 o + Planning & Development Department � � ��at��r Petition for Annexation � Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed — PRINT full names: Donald B. Lay 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 1276 Sedeeva Circle North 3. That this property constitutes the property for which a request for (describe request): Annexation of a single family residence 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 application; 7. That (I/we), the undersi ned author' , hereby certify that the foregoing is true and correct. �" �� Property Ow r Property Owner Property Owner STATE OF FLORIDA, COUNTY OF PINELtAS Property Owner BEFORE ME THE UNDERSIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON THIS O'�3¢'� DAY OF � Pt"� � 7� �`�—y ZDI S , PERSONALLY APPEARED QCI..+(] g . 1...- WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTAfj4�5 TH�C�NTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Seal/Stamp Notarv P My Commission Expires: ROBERTA L. GLUSKI Commission # EE 90467 Bondad TArouph Naiionsl Notary Assn. 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 LL � �� rwater ��a U PROPERTY OWNER (PER DEED): Donald B. Lay Planning & Development Department Petition for Annexation Sunnlemental Statement MAILING ADDRESS: 1276 Sedeeva Circle North, Clearwater, FL 33755-1141 CITY OF CLEARWATER CASE NUMBER: 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 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 oZ3� day of � Si ature of property owner (individual r authi representative of corporation, partnership or ot entity) Signature of co-property owner J� U,�c,�-� . �. bY �N �� , who is personally known/has duced ��t �� 1�s as identification. /1, 4-t G�Ns� My commission Notary Public - State ot FloriCa Ay Comm. Expires May 27, 2015 Bo�ed Throuph Nationa! Notary Assn. Planning 8 Development Departrnent, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 7 of 7 Revised 03/13 �...,._..._ ._. f � h � .��:1 i ��, . � a�at � � �t ; DF2�9 �: :TF VC HEV r07AL _'-� `� . ,> ., � . � XAfdEEH F. DE BlN(ER� L'IEFx OF (�II�T Pl}Elt�6 CQI{{Y� flORIDA 7Dis documcnt ��ns prqwmi by w�d tnuit ta; _.__.�______�—ti__�_____-- ��nN c. i.nnY 1CJ47Bb2 ll-09-2000 lO:Ob:35 JAG 127f� Nonh Seda:�a Circk 51 DE6-J LAY ;^, C►arµ'uur. Flurida. 33755 � � WARRAN7'YA��D Ia: �: SPG: EPG: ',,' f�AI1G 001 PRGES 1 tb.00 _'�-_� , 'fI lIS DEC• D, made �his �1�tilLduy of NOVEMBER , nw�i_ baw�cn DOC STANP - DR2t9 3 tb3.00 _�'- - 1EAN G LAY. : a�ed xnnun. IOTi1L: Sf,9 J18• -,�• �-� �hc yuMa. whosc �ddras is 12�b NonA Scdecva Circl� ClmrWaicr. Fioridu, t3755 P(�pI A1i1.1F1�ERED: :36� DD '� ql{iH'iE: � f.6Q .' ,' IEAN C. LAY ond DONALD D. LAY, iIUSBANU ANn WIF� 8Y � IfPIJfY CIE�( ,--� � IIIC $�AqkC. N'IIOSC AA{:fti31S 127G Nanh Scdec��n Circic. Ciwnrplor. Floridu. 33755 -- �' i � . . WITNESSEfhI. Umt �hc gamcu. far nnd in considc►ation of thc wm of ITRANSFL•R WITHIN FAMILY � NO �n •� `'� • CONSIDEitA'TI(N! INVOLVBP� thc rcccip oad mlficicncy of HAich ic Ixrcby xknowlatged ax! iacir `yd, sud ?°,, for ahet good and �vluabk rnnsidcration, Aas ganled 6ar�ducJ. wW wid com�c�•od, und M' �S txa�Mwd�s rm- A•� ymq. 6wbmin ull. com�ey wid confitm unlo thc �mlce. Ihcir hei�s nnd nuiyms fac�wr. aiY �bc-raY prop.'qy: �, Iosq►xx xilh impm�emcn�s, if w�y, silwlc mx! being in thc Courny of PINELLAS, SiWC af F;�.�ffilPA , dacril�Cd M� ra follows: � � � � � � m _ � � � i �p= 7trc Wal Ip fal of La 2 mid all of Lol z. LESS Ihal portioq of Lot ), us (otlo��s: �. •� �� ,� m o - Dcgio �t thc sa,u�»w can« ur Loi 1 ra Poin1 or ec�inn�n�;, run Eas1 on d�c �oulh rne M Lot �.`�o rat.'u�na B" "NortA a6 fcq, tAcncc North�csicrly �S fcd ro a poinl SR kc1 GW and +{ kd South of Ux NoMN�at tDrt�ct of L.ot �-- a �. tIk11CC NOfih �{�: �CCI ►O p DD1M OM1 IhC NO(IJ1 IItIC 0� Lq 3. Ihill 1L 8 COC} �ASI O� 1�1C TIOI1bWC51 W�lICt O( lAI 1, 0• p �-�bencc Wccl on Ilrc Nw1A linc of La 3, 8 fec1, Ihc»ce Saalh 13S fccl 1q ihc Point of 9c6inning; F40RADEL � mp. �-SUDPIVISION, ps r000rdod in PIal9ook I5. Pagc 7. Public Rxords of Pinclbs Cputty, Flori� �� o � , � � � � ' Ico knoH n as waK und numbcr as 1276 NORTH SEDEE VA ClR��P; C�catwuk� Fton�da; .137s3 � A � . ___ .�',,'�, �..' � ` is comc�una is mude wbjal to rcuriclions. rescrvWiOns wd t�len+cn}s'oFrceord; � � 7'OGEfF1ER with nll w�d cingulnr hacdimmcros and uPputlgnooccs thtmMto �clon6ing or in pnywiu arperuuning , ond t1x m�ersion mid mrrsions, remeindc� und�tErimindcrr �dtts, is�ks. nnd profia �1�0� cnd all 1bc csWtc, righ�, U�Ic, i�Naat. c4um end demand H�luqs�ci�r d tl� said graitoT ei�ha' in bw or oquity. of, in and w the ohove bury�ined prcmixs. Nith Ihe heredilunxtius �tnJ upqtrtcw�ar.. �> �� . ` TO hUVE ANQ TO HOLD thc sni4lp�cmisoc n6ovc bargAined�md dcccribcd, wi� 1hc appuncnonccc, unlo thc said Gmniee. llrcin c�iR wid oseis� ��j•� And'tbo stpd gran(o,I, for hinuelf, his heirc, uad pusonol reaaenw�ives. doa rn�enu�M. Bra�N bar6nin.ahd eBrca !a Qnd k+tt! !li�. �a. thcir bcirc ani uscigns, lim� al Ihc wuc of thc CIISCAII718 OIId (ICII�'Cty 0� jiRSC pIC5Cf115, tS N'C�I iCl%C(i 0� IIIC pfC1INSCS pbD'VC GOqt'C)IClI. (WS g00(� SII(C, �IC!(Cf.Y. absolu�c indcfcasiWe cs�ntc i(inDcritan�s, inlsw. fi;c simplc, and has good ribh6 !afl powsr und lnwfu! nuthority i u! `� to gmnl, bargain. �cll antl cbavcy,llir, samc in miuder wid form nforccuid, and ih�1 thc c�unc wc frcc wid dcar from � ail fwma aad wl�ef�s: 6ol�ine, salce. licns, wxcs, usscssrncnls, cncwnbnuia�s wKt rcsuicGo� of wry kind or � mlurc whalsocytr..c.�ecp1 wrycasorocnls, rcxuictions, catmnls, zming ordironcea and righlwf•u�ay of rccord wKf � i�P�Y �uafs rocn�i� R�x"u io� , n licn na yc1 duc wd �vMe. Thc gmnlw cMll7uid will WARRANT AND FORC•VER DEFENp tAc obo�ti-barbmincd {xcmiscs in Ihc quid azid � prn�6lc posscssion ef Ihc grnrNOr, tus h�hrs. and assigns, uyhinsl nll arut c�•cq� person ot persons tawfull�• cluinring a�Nlalc dr�uiy.paM)r.�cof• Thc singulur shpll iqcludc Ihc �lurnl. tDc plural sMq incliuic t�c cingular. wid tAc asc � � otmy g�ndcr 31�uut�bc i�iiablc ro nll gcndcrs. ; ; �IN W 1NESS 4yHEREOF, Ihc Srwuor !ws c.�ccutcd this dad on Ihc dalc cct forlh alwvc. __ - `��""�"` �' . � _ -'�� rHL��/'��{�fi,/��3 n c. L,rv � uti ayt� �icphso,_ <Qtru W F1uriJr» «Goumy o! Piacllxx�> 1 Hcrcby ccnifj•, tha on ihis day personolly upprnrat bcfac me, nn o�ccr duy uuJarizcd to udministcr ooths and tnkc uckuo��lcdgnxnls JF.AN C. LAY who prodkcd URIVER I.ICHMSr us idrntifiwtion or �vho ie personally knw�� ro mc and acknowkd6rsi bcforo nx thnt thcy cxccutai thc sumc Gccly w�d volunuuily for thc qupoce tlracin c�presscd �W� my hancl w�doffkial scnl tlus � dutc of Nc'- 2�uN) ��:-��-- � �. � Nolury� Public. m�� commission cspires 7'i',',�y, CAROI E.6EETEH ,;� 11YC0AlAp58qN►CC7W669 �l E%PIf1E& BpqnWN i, 200Q l/ ao�wwnn+nWn+kuwnMwh LL ° � earwater U Planning & Development Department Petition for Annexation ALL APPUCATIONS ARE TO BE FILLED OUT COMPLETELY AND CORRECTLY, AND SUBMI7TED IN PERSON (NO FAX OR DEUVERIES) TO THE PLANNING & DEVELOPMENT DEPARTMENT BY NOON ON THE SCHEDULED DEADUNE DATE. A TOTAL OF 14 COMPtETE SETS OF APPLICATION AND SUPPLEMENTAL MATERIALS {i ORiGINAL AND 13 COPIES) AS REqUIRED WITHIN ARE TO BE SUBMITTED FOR REVIEW BY THE DEVELOPMENT REYIEW COMMITTEE. APPLICATIONS AND SUPPLEMENTAL MATERIALS ARE REQUIRED TO BE COLLATED AND STAPLED INTO SETS. IT IS INCUMBENT UPON THE APPUCANT TO SUBMIT COMPIETE AND CORRECT INFORMATION. ANY MISLEADING, QECEPTIVE, INCOMPLEfE OR INCORRECT INFORMATION MAY INVAUDATE YOUR APPIICATION. THE APPLICANT, BY FIUNG THIS APPL1CA710N, AGREES TO COMPLY WITN ALL APPUCABLE REQUIREMENTS OF THE COMMUNITY DEVELOPMENT CODE. APPLtCATiON 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): Jeremy T. Fisher and Nicole S. DeCicco MAILING ADDRESS: 1271 Palm Street, Ciearwater, FL 33755-1130 PHONE NUMBER: EMAI L: AGENT OR REPRESENTATIVE: MAIUNG ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJER 1271 Palm Street, Clearvvater, FL 33755-1130 PROPERTY: PARCEL NUMBER(S): 03-29-15-46998-000-0140 LEGAL DESCRIPTION: Knight's Acres lot 14 CURRENT CITYSFRVICES: REQUESTED CITY SERVICES: x (select all that appJy) SANITARY SEWER SANITARY SEWER SOIID WASTE x x SOLID WASTE WATER Pfanning 8� Devebpmerrt DepartmeM, 100 S. Myrtle Avenue, Ciearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 1 of 7 Revised 03H3 LL ° � ear�vater Planning & Development Department Petition for Annexation � Data Sheet PLEASE ENSURE THAT THE FOLLOWING INFORMATION IS FILLED OUT, IN IT'S ENTIRETY. FAILURE TO COMPLETE THIS FORM WILL RESULT IN YOUR APPUCATION BEING FOUND INOOMPLETE AND POSSIBLY DEFERRED UNTIL THE FOLLOWING APPLICATION CYCLE. FUTURE LAN� USE PLAN DESIGNATION PRESENT (COUNTY): Residential Urban (RU) RE4uESTED (cITY): Residential urba� �RU} ZONING DISTRICT PRESENT (COUNTY}: R-4, One, Two and Three Family Residential REQUESTED (CITY): Low Medium Density Residential (LMDR) SITE AREA: 0.118 5lZE OF DEVELOPMENT : 6cisting: 1 Proposed: 1 (e.g., number of units, hote! rooms vr non- residential square footagej acres USE OF PROPERTY: Existing (currently on site): Single Family Proposed (new use, if any; plus existing if to remain): Single Family If residential use, is unit(s) rental? � Q STATE OF FLORIDA, tOUNTY OF PINELLAS I(we), the undersigned, acknowledge that all representations made in this applicatio� are true and accurate to the best of my knowledge and authorize City representatives to visit and photogreph the property described in this application. �,h Swom to and subscribed before me this � 3 day of ��nu a • �Q1�• by N�c�� -�n+ Y r F��', �E CsCCo , who is personally known/has owner or representative My commission expires: owner or representative �s�r s. sH�w MY COMMISSION �Y FF 1 EXPIRES: May 28, 2 Planning 8 DeveloQmerrt DepartmeM, 140 S. Myrtle Avenue, Clearwaber, FL 33756, Tet: 727-562-4567; Fax: 727-562-4865 Page 2 of 7 Revised 03/13 ° a er � C ear�v t U Planning & Development Department Petition for Annexation Submittal Package Instructions & Checklist IN ADDITION TO THE COMPLETED ANNEXATION PEfITION FORM, ALL PETITION FOR ANNEXATION PACKAGES SHALL INCLUDE A SUBMITTAL PACKAGE THAT INCLUDES THE FOLLOWING: ❑ Signed and sworn (notarized) disclosure of interest statement (form attached). ❑ if the property is not a piatted lot of record, a current survey identifying the dimensions, area and location of the property having been prepa�ed, signed and sealed by a land surveyor currentty registered in the State of Fiorida within the most recent 12 months. [Note: Submit two copies onl yj 0 If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plat, and engineering plans. ❑ Terms of a proposed Agreement to Annex, if any. ❑ If the proposed annexation requires a change in the land use classification and zoning category assigned to the property, a justification for such change must be submitted in writing. lf the requested zoning is not consistent with the Future Land Use Map of the City of Clearwater Comprehensive Plan, the applicant will be required to file a companion application to amend the map. ❑ Proof of ownership (e.g., copy of deed, title insurance policy, or other instrument demonstrating ownership). [Note: Submit two copies onlyj ❑ If connection to city services is desired prior to the effective date of the annexation, applicant must provide notarized Petition for Annexation Supplemental Statement (form attached). (Note: Submii originol onlyJ ❑ If applicant is designating an agent/representative to work with City, applicant must provide notarized Affidavit to Auihorize Agent/Representative (form attached). [Note: Submit original only) !!+lFORMATl�l�! P�(;!!!P.'FD T'a CO�lAPLETE Tl3E PET!'T!O!1! K?R ANNEXATlON APQl.lf:AT10111 AND D�TA SHE'FT CA!'d SE FOUND ON THE FOLLOWING DOCUMENTS AND/OR ONUNE AT THE FOLL�WING WEBSITES. IF THE APPUCANT IS UNCERTAIN WHERE TO LOCATE THIS INFORMATION OR NEEDS ADDITIONAL ASSISTANCE, PLEASE CONTAtT THE PLANNING AND DEVELOPMENT DEPARTMENT, LONG RANGE PLANNING DIVISION AT 727-562-4567. ❑ PARCEI NUMBER (Parcel I.D. Number) can be found on the Warranty Deed. It can also be found by searching the Pinellas County Property Appraiser's Office website at www.pcpao.org (search database by address). 0 LEGAI DESCRIPTION can be found on the Warranty Deed. It can also be found by viewing the property record online at the Pinellas County Property Appraiser's Office website at www.pcpao.org. ❑ FUTURE LAND USE PLAN DESIGNATiON (COUNTY) can be found by viewing a Property Report using Pinellas Count�s Public GIS Viewer available online at http://�is.pinellascountv.org/public gis/. Search by property address or Parcel I.D. Number and report will appear. ❑ FUTURE LAND USE PLAN DESiGNATION (CITY) is typically the same as the land use designation in Pinellas County, unless applicant is proposing a change (see submittal package requirements for more information}. 0 ZONING DISTRICT (COUNTY) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://�is.pinellascountv•org/public gis/. ❑ ZONING DISTRICT (CITY) can be found by contacting the Planning and Devefopment Department or viewing the City's Zoning Atlas, avaiiable online at http://www.mvcfearwater.com/�ov/depts/pwa/en�in/publications/en�atlas/atlas.asp. 0 SITE AREA (ACRES) can be found by viewing a Property Report using Pinellas Count}rs Public GIS Viewer available online at htt�://�is.pinel�ascountv.org/public gis1. Planning 8 DevelopmeM Departrner►t, 100 S. Myrtie Avenue, Clearwater, F� 33756, Tel: 727-562-4567; Fan: 727-562-4865 Page 3 of 7 Revised 03/13 0 � � earwater U ATTENDANCE AT PUBUC HEARINGS Planning & Development Department Petition for Annexation Information for Applicants The applicant or applicanYs representative is encouraged to attend City Council public hearings unless the annexation pertains to a property developed or to be developed with one single famiiy dwelling. STANDARDS FOR ANNEXATION In determining whether to annex a property, the City shall consider the extent to which: ❑ The proposed annexation will impad public services {e.g., water, sewer, police, parks, etc.). ❑ The proposed annexation is consistent with the City of Clearwater Comprehensive Plan. 0 The proposed annexation requires a change in the future land use and zoning classifications assigned to the property as well as the jurisdiction for said change. ❑ Existing or proposed development is consistent with City regulations. ❑ Terms of a proposed Annexation Agreement, if any, promotes the City of Clearwater Comprehensive Plan. PROPERTY OWNER AGREEMENT Please be advised that, in consideration of the annexation, the property owners do hereby agree that: 0 All structures and improvements which are erected upon said property subsequent to the date of this petition for annexation shaN comply with all applicable City of Clearwater regulations and ordinances as set forth in the City Code of Ordinances; ❑ All residential rental units, including single-family residences must comply with the requirements in the cit�s residential rental ordinance, which requires the property owner to obtain a Business Tax Receipt upon annexation into the city; ❑ If development is to be initiated prior to submission of an annexation petition and/or prior to the effedive date of the annexation, requisite site plans, plat, and engineering plans shall be submitted to ensure compliance with the city's Community Development Code (see Submittal Package Instrudions Checklist). It is recommended that the applicant meet with Planning and Development Department staff to review plans and/or discuss the applicable city regulations; ❑ All annexations of residential dwellings of eight dwelling units or more shall convey such recreation facilities fees and recreation land dedication and/or fees in the amount and manner prescribed by Chapter 54, Article tl of Gearwater Code of Ordinances; and O When any substandard abutting street or utilities are subsequently upgraded by the City to meet City Standards, said '+mprovement(s) will be done on an assessment basis, consistent with City procedures therefore. Pianning � Developmerrt Depa�tme�t, 140 S. Myrtie Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fau: 727-562-4865 Page 4 of 7 Revised 03/13 LL ° � earwater U PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAIUNG ADDRESS: PHONE NUMBER: EMAII: Planning & Development Department Petition for Annexation Disclosure Statement Jeremy T. Fisher and Nicole S. DeCicco 1271 Palm Street, Clearwater, FL 33755-1130 7a4 - as - t3dd OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT 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 OP'TIONS TO PURtHASE THE SUBJECT PROPERTY? PARTIES INVOLVED — NAME: NAME: ARE THERE ANY MORTGAGES OR UENS ON THE SUBJECT PROPERTYT PARTIES INVOLVED — NAME: NAME: _ YES �_ NO PHONE NUMBER: PHONE NUMBER: _ YES _� NO PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: �_ NO STATE OF FLORIDA, COUNTY OF PINEUAS 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 dexribed in this applicati n, Sworn to and subscribed before me this _� �� day of ' 0 I . by ��-E � n• - ��-�� Y T• � � ��x who is personaliy knownJhas . .—� n „ of proy�erty yGvner or representative My commission expires: �%�� ;j�{;" owner or representative as identification. LESLEY S. SHAW MY COMMISSION x FF t Planning & Devebpmerrt Department, 100 S. AAyrtle Avenue, Clearwater, Fl 33756, Tsl: 72T-562-4567; Fax: 727-562-4865 Page 5 of 7 Revised 03/13 LL ° � earwater Planning & Development Department Petition for Annexation " Affidavit to Authorize Agent/Representative 1. Provide names of al) property owners on deed — PRINT fufl names: Jeremy T. Fisher 1 1 / 2. That (1 am/we are) the owner(s) and record title holder(s) of the following described property: 1271 Palm Street 3. That this property constitutes the property for which a request for (describe �equest): Annexation of single family home 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 affert such petition; S. That this affidavit has been executed to induce the C►ty of Clearwater, Florida to consider and act on the above described property; 6. That site visits to the p�operty 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 applicati on; 7. That (I/we), the undersigned authority, hereby certify that the foregoing is true and correct. � � Property Owner Property Owner Property Owner Property Owner STATE OF FLORIDA, COUNTY OF PINELLAS BEFORE ME THE UNDERSIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON THIS ��h DAY OF d GGYLU ,�/.5 . PERSONALLY APPEARED IJj� �al� WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVff THAT HE/SHE SIGNED. ;:� �,•', LESLEY S. SMAW ;�� ',= MY COMMISS�•�n r FF 157217 �.�:;= EXPIRE� May 28, 2017 �.�$� �d; � Bonded Thru NoWry PuWic Undeiwriters Notary Seal/Stamp My Commission Expires: � Public Signature Plaoning $ DeveFopmerrt Depardnerrt,100 S. Nfyrtie Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 6 of 7 Revised 03/13 LL ° � earwater Planning & Development Department Petition for Annexation � Supplemental Statement PROPERTY OWNER (PER DEED): leremy T. Fisher and Nicole S. DeCicco MAIUNG ADDRESS: 1271 Palm Street, Clearvvater, FL 33755-1130 CITY OF CLEARWATER CASE NUMBER: I/we, J rn �. F1 S � C� �il �.�� [insert names of a roperty owners], having filed a Petition for Annexation regarding the above property/case number, grant consent, agree and acknowledge that the City of Gearwater 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. 1/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 cty representatives to visit and photograph the property described in this applicatioa Swom to and subxribed before me this �h day of a r ___6:�l�Z_• bY , N-i-C �E ��A1 i T• �t1 ? t� �C�.CCb who is personally known/has �� _ _i�/I �j� produced � � ( _7�� as identification. entity) owner (individual or authorized �oration, partnership or other My commission expires: owner LESLEY S. SHAW MY COMMISSION #� FF 157247 EXPIRES: May 28, 2017 Planniog 8 Devebpmerrt DepartmeM, 100 S. Myrde Avenue, Clearwater, Fl 33756, Tel: 727-562-456T; Fax: 727-562-4865 �� 7 � � Revised 03H3 #: 201310�8�2 BK: 17947 PG: 380, 04/03/2013 at 09:11 AM, RECORDING 1 PAGES 10.00 KEN BURKE, CLERK OF COURT AND COMPTROLLER PINELLAS COUNTY, FL BY EPUTY CLERK: CLKDUIO �p , p0 Prepared by: Patricia S. Hazel Security Title Company 791-A San Christopher Dr. Dunedin, Florida 34698 File Number. 1315309 � C� _.� ,�,� General Warranty Deed ; � Made this Mazch�� 2013 A.D. By Lutber Fbyd, heremafter called the grantor, to Jercmy T. F'uAer aad Nieok S, DeCicco,�,' �� ` whou post office address is: 1271 Palm St. Cfearwater, FL 33755, hereinafter plled the gantce: '' - � � � � � � , �, (W6eneva uud Aacin tAc tertn "granta' and'geMet" includt dl lhc pvties to Uis insUUmcnt and the heirs. kg�J rcpaenntiva o�d auigm o� ` �� individusls, and Ilfc succeswn and atsigra of torpaationt) _, �� WltnCSSeth, that the grantor, for and in consideration of the s�un of Ten Dollars, (�10.00� and othcr valuable considerations, receipt whereof is hereby aclawwledged, hereby gants, bargains, ulls, aliens, remises, nleascs,�conveys and confirtns unto the granta, all that ceRain land situate in Pinellas County, F7orida, viz: ,� Lot 14, KnigLt's Acres, according to the map or plat thereof, ss recorded in Plat Boql�?� page(9j GG, of�t►e Poblic Rceords ot Pinellas Cousry, Fbrida. `� � ��" �� ` � , Subject to resu-iMions, reservations and easernents of record and rcal estate taxes for the yea�2013 ead subscqueM years. Said property is not the Aomestead of the Grantor(s) under the laws and constitutiolYOfthe9tate of�loridain,ihat neither Grantor(s) or any members of the tw�uehold of Grantor(s) reside thereon. � � , �> i� �� Parcel ID Number. 0.�29-15-46998-000-014� �� • ' �� Toget6er wi�h all the tenemenu, hcrcditaznents and appiqtenances't�ie?eto beiong5ng or in anywise appertaining. To Have and to Hold, the same in fee simple f�ever. , �.� And the ganton c�reby covenanes with�ssid g'�tee thatthe gantor is lawfu0y seized of said land in fee simple; d�at thc grantor has good right and lawful authority to sell an(d aonvey saijl'1and: that the gantor hereby fully warrants the titk ro said land and will defend the same against the lawful claims of a0 persohgirlw4qScever, and that said land is free of alI encumbrances except taxcs accruing subsequent to Decembcr 31, 2012. ---- In .W itness Whereof, the s5id grantor A�s ,�ignedand sealed these presents the day and year fust above written. �� '' Signed, sealed and del ivered in orh; presence: � � / ' ' - � Q�-(C,V/`'�.ci �/� (�1) ' ' - _ � Lutkcr Fbyd WiuxssPrintcdNamc `�Av/,�+.7 �—�uCL��✓O Address: � � � _ (SC31) W�tr�usPriMCdNarx�. — �'e� C.f . ��Y{lPS Ad�as: T� State of Virginia Countyof 1 ✓� t � The foregoing insuwn was aclmowlgdged before me ttiis Znd�y of March, 2013, by Luther Floyd, wtro is/are personaliy Imown to me or who has produced ��) up� S �� C Pti S%� identification. n ` ) 1 �a ln.'L k-a.' U�/ �� i ��uti��u�,�,, NohryPublic � Sam� ' �J �,D W$,,� �i� Pri�t Namr. 0 9 �Y� yr1 a r �� W '� �� n : n�?. �T�9 : My Comoivioe E:pim: :/ 5^ 3�� L� DEED Indnidua] Warranry C�ccd With'7nn-FNwu�lr. ��k�cis' C,-tw�rcc ., � , �, �, __ , _ �'-,� .` ., `� . `� � .. �� _ „ � 0 � C :earwat�r 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 COMPIETE 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: $� IMPACT FEE/ASSESSMEN7 FEE: TBD Information on /mpact Fees or Assessment Fees is avai(able from the City of Clearwater Engineering Department (562-4747). PROPERTY OWNER (PER DEED): �r Sc�___`al� a►►—.�� Dc��r, M`,�.4.� TncL�er MAILING ADDRESS: ��,33 P�rl rh St� Cl,�r ,�.�t i�L 337.�5 PHONE NUMBER: EMAIL: v[�e_-f..�n.h�� p��(e�r'�s,�-cr ��.►� AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBIECT PROPERTY: �Z'�'� P�,,.� g^r PARCEL NUMBER(S): Cj--3- �c.�_� T�-. � rjKc.rV - bn7,, _��t�� LEGALDESCRIPT►ON: ��w v'� �lo� �T �-,�- �� o$ 1� �� ql( aA lo-r-�_ CURRENTCITYSERVICES: SANITARYSEWER REQUESTEDCITYSERVICES: � SANITARYSEWER (select all that apply) SOLID WASTE ?� WATER � SOLID WASTE Planning & Dev_elopment Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tei: 727-562-4567; Fax: 727-562-4865 Page 1 of 7 Revised 03/13 o ,_; � ��earwater � Planning & Development Department Petition for Annexation Data Sheet PLEASE ENSURE THAT THE FOLLOWING INFORMATIOIV IS F{LLED OUT, IN ITS ENTIRETY. FAILURE TO COMPLETE TNIS FORM WILL RESULT IN YOUR APPLICATION BEING FOUND iNCOMPLETE AND POSSIBLY DEFERRED UNTIL THE FOLLOWING APPUCATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY): REQUESTED (CITY): ZONING DISTRICT PRESENT (COUNTY}: R REQUESTED (CITY}: (,n, SITEAREA: d.11 rj acres SIZE OF DEVELOPMENT : Existing: � Proposed: � (e.g., number of units, hotel rooms or non- residential square footoge) � _�� r�� rw� �� Il,O�`.e:_��_1 Lt,M USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; pius existing if to remain): If residential use, is unit(s) : enia!? Si n_—��—�` � � �% _—. � �,in�.r�l.e �1�/ 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 ��''� , 'Z.v�S' . by __.----- _ � who is personally known/has i�- � Signature of property owner or representative Signature of property owner or representative produced �L.OR.t.�+� 1D as identification. T�4- y9.� ' �1- d�.�{-o No,Yar�/public, `� 8 c8 lb My commission expires: �� `````�Y u�.,4,, . J. M. ANOIIEWS _, , d fbrM Mlyr Con�•,E�� Aw t�. �E � .� Con�uk� i R /521i0 � •. �� „ Planning & Oevelopment Department, 100 S. Myrtle Avenue, Clearwater, FL 33i56, Tel: 727-562-4567; Fax: 727-562-4865 Paye 2 of 7 Revised 03/13 0 } ��arwater U 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 7HE FOLLOWING APPLICATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (CO�NTY): REQUESTED (CITY}: ZONING DISTRICT PRESENT (COUNTY): R REQUESTED (CITY): � SITE AREA: d. � 1� acres SIZE OF DEVELOPMENT : Existing: � Proposed: t (e.g., number of units, hotel rooms or non- residential square footoge) 0 0 USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; plus existing if to remain): if residential use, is unit(s) rental? � Iv 1`tS i �,inc,�it �i ly / �i..�� '��I.l 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 �R.�.�Ac�"� , `�.C1S� . by , who is personally known/has \ produced �IrOi1.4�� iD as identification. Signature of property owner or representative T�4—�'(9��' ,�� d�`� _ ��/l� Signature,of prope�$� o�er or re� v �� r �� `� ^� � �/ ,�(.��'� � C�� S�" � ��/ ^ PI� a� ��S��e o`�� D�F 0 �0 `'�a O��tiA��S �Q`�,�\\t��,�.Q�� 6 �l�• %� � No,t'�ar�pubiic, � � � My commission ex 8/rs/18 J, M. AMOIIEW3 at florNi Mh► Comw.,E�yihi Art N. �01 Co�fN�io� 1 R t� i0�3�f�li.�a t, 100 S. Myrtle Avenue, Clearwater, FL 33�56, Tel: 727-562-4567; Fax: 727-562-4865 �,� �o�� Revised 03/13 m LL 0 �_� �arwater U Planning & Development Department Petition for Annexation Submittal Package Instructions & Checklist IN ADDITION TO THE COMPLETED ANNEXATION PETITION FORM, ALL PETITION FOR AIVNEXATION PACKAGES SHALL INCLUDE A SUBMITTAL PACKAGE THAT INCLUDES THE FOLLOWING: 0 Signed and sworn (notarized) disclosure of interest statement (form attached). ❑ If the property is not a platted lot of record, a current survey identifying the dimensions, area and location of the property having been prepared, signed and sealed by a land surveyor currently registered in the State of Florida within the most recent 12 months. [Note: Submit two copies onlyJ 0 If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plat, and engineering plans. ❑ Terms of a proposed Agreement to Annex, if any. ❑ If the proposed annexation requires a change in the land use classification and zoning category assigned to the property, a justification for such change must be submitted in writing. if the requested zoning is not consistent with the Future Land Use Map of the City of Clearwater Comprehensive Plan, the applicant will be required to file a companion application to amend the map. ❑ Proof of ownership (e.g., copy of deed, title insurance policy, or other instrument demonstrating ownership). [Note: Submit two copies only] ❑ If connection to city services is desired prior to the effective date of the annexation, applicant must provide notarized Petition for Annexation Supplemental Statement (form attached). [Note: Submit original onty] ❑ If applicant is designating an agent/representative to work with City, applicant must provide notarized Affidavit to Authorize Agent/Representative (form attached). [Note: Submit originol only] wGnanner�nN RFni i1RFn T(1 f(1MP1 FTF THF PFTITInN FnR ANNFXATI(�N APPI I�ATI(�N ANf� nATA $HFFT CAN 13F FOUND ON THE FOLLOWING DOCUMENTS AND/OR ONLINE AT THE FOLLOWING WEBSITES. IF THE APPLICANT IS UNCERTAIN WHERE TO LOCATE THIS INFORMATION OR NEEDS ADDITIONAL ASSISTANCE, PLEASE CONTACT THE PLANNING AND DEVELOPMENT DEPARTMENT, LONG RANGE PLANNING DiVISION AT 727-562-4567. ❑ PARCEL NUMBER (Parcel I.D. Number) can be found on the Warranty Deed. It can also be found by searching the Pinellas County Property Appraiser's Office website at www.pcpao.or� (search database by address). ❑ LEGAL DESCRIPTION can be found on the Warranty Deed. It can also be found by viewing the property record online at the Pinellas County Property Appraiser's Office website at www.pcpao.or�. ❑ FUTURE LAND USE PLAN DESIGNATION (COUNTY) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://�is.pinellascountv.or�/public �is/. Search by property address or Parcel I.D. Number and report wili appear. ❑ FUTURE LAND USE PLAN DESIGNATION (CITY) is typically the same as the land use designation in Pinellas County, unless applicant is proposing a change (see submittal package requirements for more information). ❑ L �❑ ZONING DISTRICT (COUNTY) can be found by viewing a Property Report using Pinellas County's Pub►ic GIS Viewer available online at http://�is.pinellascountv.or�/public �is/. ZONING DISTRICT (CITY) can be found by contacting the Planning and Development Department or viewing the City's Zoning Atlas, available online at http://www.myclearwater.com/�ov/depts/pwa/en�in/publications/engatlas/atlas.asp. SITE AREA (ACRES) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://�is.pine{lascounty.or�/public �is/. Pianning & Development Department, 100 S. Myrtie Avenue, Clearwater, FL 33756, Tel: 727-562-456T, Fax: 727-562-4865 Page 3 of 7 Revised 03/13 „ o , � �learwater U ATTENDANCE AT PUBLIC HEARINGS Planning & Development Department Petition for Annexation Information for Applicants 7he applicant or applicant's representative is encouraged to attend City Council public hearings unless the annexation pertains to a property developed or to be developed with one single family dwelling. STANDARDS FOR ANNEXATION In determining whether to annex a property, the City shall consider the extent to which: 0 The proposed annexation will impact pubiic services (e.g., water, sewer, police, parks, etc.). 0 The proposed annexation is consistent with the City of Clearwater Comprehensive Plan. 0 The proposed annexation requires a change in the future land use and zoning classifications assigned to the property as well as the jurisdiction for said change. ❑ Existing or proposed development is consistent with City regulations. 0 Terms of a proposed Annexation Agreement, if any, promotes the City of Clearwater Comprehensive Plan. PROPERTY OWNER AGREEMENT Please be advised that, in consideration of the annexation, the property owners do hereby agree that: ❑ All structures and improvements which are erected upon said property subsequent to the date of this petition for annexation shall comply with all applicable City of Clearwater regulations and ordinances as set forth in the City Code oi Ord�narces; 0 All residential rental units, inciuding single-family residences must comply with the requirements in the city's residential rentai ordinance, which requires the property owner to obtain a Business Tax Receipt upon annexation into the city; ❑ If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plat, and engineering plans shall be submitted to ensure compiiance with the city's Community Development Code (see Submittal Package instructions Checklist). It is recommended that the applicant meet with Planning and Development Department staff to review plans and/or discuss the applicable city regulations; ❑ All annexations of residential dwellings of eight dwelling units or more shall convey such recreation facilities fees and recreation land dedication and/or fees in the amount and manner prescribed by Chapter 54, Article II of Clearwater Code of Ordinances; and 0 When any substandard abutting street or utilities are subsequently upgraded by the City to meet City Standards, said improvement(s} will be done on an assessment basis, consistent with City procedures therefore. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 4 of 7 Revised 031'13 „ 0 � ��arwater U Planning & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): �p s<ph nr.c� T7 u r��. /'� �w✓��t Ti ✓� cU-e.r MAILINGADDRESS: �Z�3 �G\,r,� S1- � Cltarwa-t't✓ -� ��- 337,�� PHONE NUMBER: EMAIL' '�cX..-�.-,cY•�r- e r-�+�1�„r..�o't+cr-..co..,, AGENT OR REPRESENTATIVE: MAILING 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 SUBJECT PROPERTY? PARTIES INVOLVED - NAME: !VHlVIt: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? PARTIES INVOLVED - NAME: �2�lo�nS l�a'"� � NAME: _ YES � NO PHONE NUMBER: PHONE NUMBER: YES � NO PHONE NUMBER: F'1'IUIVt IVUIVI[StK: �C YES NO 7— PHONE NUMBER: � �00 -��-Z��Z 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 applicati Sworn to and subscribed before me this � day of Y�SC1.t�MrAM ?�f%t� . by of property owner or representative Signature of property owner or representative who is personally known/has produced �LOy�i4�%p� � as identification. � �'�c � �'t2� ' 02 "�— ��c�t.. ,11,�1,�..�,��. Notary public, My,commisS�'c + �� .. , .�.,� �...,..•� Pianning & Development Department, 100 S. Myrtle Aven �� ia�M��OQ �x: 727-562-4865 Page 5 of 7 Revised 03/13 ° _ i��rwater � � __ U Planning & Development Departmen Petition for Annexati Affidavit to Authorize A�ent/Renresent ive 1. Provide names of all property owners on deed — PRINT full names: 2. That (i am/we are) the owner(s) and record title 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 nea 5. That this affidavit has been executed to induce the City of Clearwater, described property; to affect such petition; a to consider and act on the above 6. That site visits to the property are necessary by City representativ in order to process this application and the owner authorizes City representatives to visit and photograph the roperty described in this application; 7. That (I/we), the undersigned authority, hereby certify that the/foregoing is true and correct. THIS Property Owner Property Owner Property Owner Property Owner STATE OF LORIDA, COUNTY OF PINELLAS BEFORE ME THE UNDERSIGNED, AN OFFI ER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON DAY OF PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND SAYS THAT HE`SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Seal/Stamp Notary Public Signature My Commission Expires: Planning 8 Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 6 of 7 Revised 03/13 � � 0 � ��rwater U Planning & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): '�'p S{�l-� Q�,,� u�u /�I �,r,"-� T� ,,., cL•.e,r MAILINGADDRESS: 1Z'9� �u\r•► S''t' f C�te.rwq�'t✓ -E �L' 337�� PHONE NUMBER: EMAIL: "�=�,.,�Y•d.r- E� r�a c1�.r..�`t�cr' cn.... AGENT OR REPRESENTATIVE: MAILiNG ADDRESS: PHONE NUMBER: EMAiL: OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SU6IECT 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: IVHIVI t: ARE THERE ANY MORTGAGES OR L{ENS ON THE SUBJECT PROPERTY? PARTIES INVOLVED— NAME: ��lnv�S .L�a'`'� � NAME: _ YES � NO PNONE NUMBER: PHONE NUMBER: YES � NO PHONE NUMBER: YI"IVIVt IVUIYILStIt: � YES NO PHONE NUMBER: � �00 —�—Z�i(DZ 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 applicatio Sworn to and subscribed before me this � day of j-�GibC1.t�V'�isM , ?�Ol� , by Signature of property owner or representative c -�t,r�� Y,�a ignako e of property� r�r r or repre a�t�'` o� �,�` �`� �t• `'��' � � �"")� ' 0 ��c•"", o�� i,�. ,� �� Pfs�i�g & � elo nt Dep�nsi�[��1�0 � \ � ,�,^ 5 �o�a� o��C \yy� a� �j\ `� �`�eu�'�, , � o�t�` � �\ , „v • ; � c, �,% :r • .� •� Vr�'� -� �� =i i • o'_ \ �� . _ . o� who is personally known/has produced �LO�i��A� � as identification. —r S'�c— i-�12� ' OZ � �. ,�1 �,�1 Notary public, My,comm�is�,c Ave �� c� /g �$ J. M. ANOREYYS ;�x: 727-562-4865 Revised 03/13 � � 0 � � �ar�vater U Pianning & Development Department Petition for Annexation Supplemental Statement PROPERN OWNER (PER DEED): Td >.��y.� u,,lr _�� Mq�'� TC,n � L�.er MA►LING ADDRESS: �2"'�'� ��,..,, S'r � ('1��,r�.�<<1^c�� L �3"7 �� CITY OF CLEARWATER CASE NUMBER: I/we, �.,c.�o� c�•� Dsdv� M�r:.c I,"n r� r [insert names of all property ownersJ, 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 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 applicatior�.- Sworn to and subscribed before me this �K'� day of �nv�i'�t , ?��s . bY Signature of property owner (individual or authorized representative of corporation, partnership or other �ntity} , � _�- �� . aIs jis of co-property owner pCi�`�c� �1�Cc � � �. i �c�c.1�(" �L�JL �Sal� ��h� �(Q� �D � 9 ��NNS a e°� F\��+0�6 � 2 2 `c�`Q',"'"e'�'Bi;��.,� No�comm ExV� � ��84 �� :: � • • ? M`I m��ss`0 :. . �?o; �° ; 3•l9T' 'f � V,: 1 f��, who is personaliy known/has produced ��' � as identification. � SZ`r 'I2 '� R ' Notary puf�+e My commissi a �� $ J. M. ANOREWS Co�l�lo� � FF 132160 i g 8 Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 7 of 7 Revised 03/13 q: 20'�3363597 BK: 18222 PG: 965, 11/12/2013 at 03:00 PM, RECORDZNG 1 PAGES 10.00 D DOC STAMP COLLECTZON $644.00 KEN BURKE, CI,ERK OF COURT AND JMPTROLLER PINELLAS COUNTY, FL BY DEPUTY CLERK: CLKCD56 Prepared by: �Mary Ball Gold Service'fitic Insurance Agency Company 4767Central Avenue St. Petersbuig, Florida 33�11 File Number. 13012214 ; '� ��'" ,� �� General Warranty Deed - _ _ ` � _ _, , Made this November 6, 2013 A.D. By -�. �� CI.iFFnRD B. DAWSON,111, ao nnmarried man Z t! ��- s r Pc� �C.- `' ' ` Wnou�aa��: 1l�0o f- � s7'n/ 1# z 337Q3 ,, hereinaRer called the grantor, to JOSEPH 77IVCHEA snd DANA MARIE TIIVCHER, hnsDrnd and wife �-' whose post office address is: 1233 Pahn Strect, Clearwaur, FL 33755 � �� , hereinafter called tAe gantee: � ' i , � � `� ` •• , � � � �� (WLeoev« uscd Aaein tlrc tcrm'granwr' and '�eMCe' include �tl tbe prtiu W �Ais 'umnrnent ard the he"vs, kgal re�resemativa and usiqn of _ � �� individuJs, ad tbc arccawfs and assigiu of co�poratiom) _ _ , �' _ �' __- Witnpseth, tbat the graotor, for and in consideration of the sum of Ten Dollars, ($10.00) and otLa valuabk consideratiaa, ��, ` rxeipt wbacof is �asby aclmowledged, hereby ganS, DarBains, setls, aliens, remises, relcases, conveys �d confirms vnW t�e �raotee> i� all that ccmin land situate in Pinellaz CouMy, Florida, vi= � Lot 14 and the East I S feet of Lot 13, Block B, Cleardun Subdivision, according to the plat thereof, recorded in Plat Book 13, Page 47, of the Public Records of Pinellas County, Flo�vda� ,� Parcel ID Number: 03-29-1�15840-002-0140 `� . , ; � , � \ •, �� ' Tog¢ther with all thc tenements, here�tarnenu and appurtenances thercto Delonghg or in �njowise appeitaining � --_ ` � To Have snd to Hold, the same in fee simple forever. _, � .�, �� , �,�� And thc gantor hereby covenants with said granta that the grantor is Iawfully seizod cf sa� land in fx sunpk; t6at t6e grantor has good rig6t and lawful authority ro sell and convey said land; tGat the �anto��eby fiilFy w�r�ants the titic w said land and will defend the same against the lawfiil claims of all persons whomsoever; and t�et 3�id t�n2i,is free, bf all encumbrances exccpt taxes accruing subsequent to Dccember 31, 2012. __, In 4Yitness 4'Vhere�f; *he sa�d ¢rantor has signs� a8d seajeH �ese nYFseuts the day and year first above writtn. Signe sealed and deliver d in o presence:,', A7f�u,�D_ _ Liiiyil�ii�:(�','� �C��--j 1.�--� r Wimest Printcd Name ��7� � �� A�'�� 233 PALM ST, Clearwater, Fiorida 33755 � ` r 1 ` ` ` .. � � � i � i i W itness Printtd Name � r\XN Y` � J ��/ i� W Address: -f-` � Stace of Florida , ' - - - _ Cwmty of Pinellas . � ` • � ,� . The foregbing�uutrwnentwasacknowledged before me this 6th day of N ember 0�, y 7FFORD B. DAWSON,III, an unmartied man, who is/are pe�rsonally l��wn to me or w}a has produced driven lice ' en ' - - Noury PrDlic �� (\ �/ PristNawe: fVU! /V �% -�� My Cosmiuioq a� � �' A4VfYA Q� �� * ��NIFF(p7D14 �1aruf e��j �N�Z��17 UEcD Indicidwl W'arnuuv L�f - Lcgal on �ace 01/30/2015 13:10 9493601491 THE UPS STORE 2950 PAGE 02 ° �I��te� U Planning & Deve�opment Department Petition for Ax�nexation ALL APPUCATIQNS ARE TO BE FILtED OU7 COMPI.ET@LY AMD CORR�GTLY, AND SUBMITTED IN PERSON (NO F�U( QR DEUVERIES} TUTNE PLANNING & QE1tELOPMENT DEPARTMEM BY NOON ON TIiE SCHEpULED DEADLlNE DAT�. A TOTAi. OF �b C731��1�'E SETS QF APPUCATiON ANp SUaPLEMENTA� MATERIALS (1 ORI�,INAL AMD 5 COPIES) AS REqu�Reo uHITHIN ARE ro B� SUBMrrrEO r-pR REYIEW Bv rri� �EVEl�PM�nrr REViEw COMMrrrEE. APPLICATIOfYS AND SUPPLEMENTAL MATERIALS ARE REQUIR�D TO BE COLLQTED AND ST'APLED INTO SETS, fT 15 IMCUMBENT UPDN THE APPLICAt� TO SUBMIT COMPLETE AND tORRECT INFORMATION. ANY MISLEADING, DEC�PTIVE, INCOMPL.ETE �R INCORRECT INF�FtMAT1l7M MAY (NVAUDAT� YOUR APPUCATION. 'rHE APPUCAnR, BY FiLING n��s APPLICATiON, AGR�ES TO COMPLY WITH ALL APPLICABLE REQUIREMENTS OF TFIE COMMUNIIY pEVELOPMENT C�DE. APPUCATION FEE: �0 lMPACT FEE/ASSESSMENT FE�: 'raa lnformaiion on lm�act Fess orAssessment Fees is available from the Ci#y of Clearwater E►tgTneerrng Depar�men# (562-4747}. PROPER'i'Y OWN�R (PER DEEDj: Tddd Sand and lenni Meno-5and MAILING ADDRESS: 26895 Alisa Creek Road, Ste 8-7Z9, Aliso Vie)o, CA 92656-S301 PHONE NUMBER: (702)-528-6637 EMAII: tsand@artisticedge.net AGENT OR REPRESEMTATIVE: MAILiNGADpRESS: 3L �p l-f-o'1/o w'''Jru.,� �- ti►, � rL �Y6�� PHONE NUMBER: r%2'7 ��r7 -� yzr �Ma��: ss s" _ � o ADDRESS DF SUBJECT PROPERTY: �063 N Betty lane PARCEL MUMBER(Sj: 03-29-a,5-izoso�oas-oo5o __ _— I�GAI DESCRIPTIQN: arooklawn Block F, S 40ft of lot 5& N 10ft Of Lot 6 CUkRF1VT�'fTYSfRVIC�S: SANITARYSEWER 50LIpWASTE R�'QUESTEDCITYSFRVICES: x SANITARYSEWER x SOLIDWASTE (select all ihot apply) � x WATER Plannfrtg � Development Departmertt. 100 3. Myrtle Avenu�, ClearwAter. FL 83756, Tel: 727-562-+t567; Fax: 727-582..486b Page T Of 7 Revised 01l15 01/30/2015 13:10 9493601491 THE UPS STORE 2950 PAGE 03 ° �l��rw � at�r U Planning & Development Department Petit�on for A,�rtexat�on �i��. ��'l��t P�EASk ENSURE THAT THE FOU.OWING 1NFQRMATI�N IS FlLLED Otl"f, IN ITS ENTIRETY. FAiLURE TO CorNPLETE THIS FQRM WILL RESULT !N YOUR A�'PUCATIOIV BEING FOUND INCQMPLETE ANp ppSSIBIY D�FERRED UNTILTHE FOLLOWiNG APPLItATIQN CYCLE. FUTURE LAMD USE PIAN DESIGNATION PRESENT (COUNTY): Residential Urban (RU) REqU�STED (CITY}: Residential Urban (RU) zoNING Di�rRrcr PRESENT {COUNTY): R-4, Qne, Two, and Three Family Residential REQUESTED (CtTY): Low Medium Densi#y Residenti�i (LMDR) SITE ,4REA: 0.116 ��res S12� OF DEVEIOPMENT : Existing: 1 Proposed: 1 {E.g., nUmber of ur►1ts, hote! rooms or nor.- r�seden:i�; s.;��rg�ootcge) 11SE OF PRQP�RTY: Existing (currenty on site}: 5ingle Family Proposed (new use, if any; plus existing if to remain): Single Farnily if res;d�nttai use, is unit{s) rentai? Yts STATE OF FLORIpA, GOUNTY QF PINELLAi l(we), the undersigned, acknowledge that alt representations made in this application are true and accurate to the best of my knvwledge and authorize City rep�esentatives to vislt and phot�graph the property described in this applic�ion. Sworn to and subscribed befare me this O� day of � .�� o � � _. by �°r� S�^ "� � r�� r ,� who �s persvnaNy known/has ��,/�+�%� �� produced ��t-�� ; 5�', C.c� � j� as identification. Signature of property o er or representatNe j} j� Notary public, My cOmmission nf pro�rfy owner _c�� DoaMl�sk�n� 200t031 �- �MMo�AIt Ce�i Planning 8� De�vetopment Departmerrt, 44p S. Myrde Avenue. Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727�562-4865 � Page 2 of 7 Reylsed D1/15 01/30/2015 13:10 9493601491 � THE UPS STORE 2950 PAGE 04 LL ° � �a�rw�ter U Plannftng & Deve�opment Depart�ment Petitio�n for Annexatinn Subrnittal Package ��struc�ians &. Check��st IN qDDITIpN TQ TFfE COMPLETED ANNDfATION PETfT10N FORM� ALI. PETtT10N FOR ANNEXAii�N PACKqGES SNALL 11VCLUDE A SUBMITTAL PACKA6� TFIqT INC�UOES THE FQLLOWING: 0 Signed and sworn (notarized) discl�sure of interes# statement (form attaChed). ❑ If the property is not a platted Iot of record, a current sunrey identifying the dimensions, are� and tocation of the property having been prepared, signed and sealed by a fand surveyor current)y registered in the State of Florida within the most recent 12 months. [Nate: 5ubmit two cop;es onlyj ❑ If developmen; is to be fniti�ted prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisi�e site plans, p1at, and engineering plans. ❑ Terrns of 2 proposed Agreement to Annex, if any. ❑ If the proposed annexation requires a thange in the land use �fassification and zoning rategory auigned to ihe property, a justification ior such change must be submitted in writing. If the requested zoning is not C�nsistent with the Future Land Use Map of the City of Clearwater Comprehensive PJen, the appli�ant will be required to ffle � �ompanion application tp �mend the map. ❑ Proof of ownership (e.g., Copy of deed, title insurance poiity, or other tnstrument dempn5trating ownership). �Npie: 5u6»�rC two capies ortly] ❑ If tonnection to City services is desired pri0r ta the effertive date of the annexation, applicant must provide nptariaed Petition for AnnexatiQn Supplemental Statement (form attached). [Note: Suhmit eriginal onlyj ❑ If appli�ant is designating an agent/representative to work with City, applicant musf provide notarized Affidavit to Authorize Agerrt/Represent�tive (forrn attached). (NOte_ Submit orig;no! only] INFORMATION REQUIRED T� COMPLETE THE PETITIQN FOR ANNEXATION APPLICATION AND DATA SHEET CAN BE FOUND QN THE F�Lt,OWING I�CUMENTS AND/QR ONLINE AT THE FOLIOWING WEBSITES. tF TH� APPI.ICANT IS uNCERTAIN wHERE TO �ocAT� THI5 iNFORMAT�ON oR NEEDS aaDirlONAL A55ISTA,NCE, p�ASE CONTqCT niE PI.ANNING AND pEVELOpM�NT DEPARTMENT, LONG RA/yGE PLANNING UIVISION AT?z7 562�567. 0 PARCEL NUMBER {Parcel I.D_ Number) t�n be found on the Warranty Deed. It can �ISO be found by searching the Pin�llas County Property Appraiser's OfFice website �t www. c ao.or (se�rch database by address}. ❑ �EGAL DESCRIPTI(aN �an be found on the Warranty Deed. It can also be found by viewing the �roperty record online at the Pinellas County Property Appraiser's OffiCe website at www.��ao.or�_ D FUTURE LAND USE PI.AN bESIGNATION (COUNTI7 c.an be found by viewing a Property Repart using Pinellas County`s Publit GIS Viewer avaii�bfe onllne at htto:/l�is.pinellasc�untY or�t/aublic__ �is/. Sparch by prOperty addre55 or Parcei I.D. Number and report will appe�r. ❑ FUTURE IANb U5E PLAN DESI6NATION (CITY) is typically the same as the land use deslgnatiun in Pinelles County, unless appli�ant is proposing a change (see submittal package requirements for more in#ormation}, G ZONiNG DISTRlCT (COUNTY) can be found by viewing a Property Report using Pinellas County's Publi� GIS Viewer avail�ble anline at http: j/ais.qinellascountv or /public Qis/, ❑ ZONING DtSTRICT (CITY) can be found by contattirtg the Planning and Develnpment Department or viewing the Cit+�s Zoning Atlas, a�dilable online at httA_://www. mvc(earwater.co m/�ov/depts/owa/enRin(pu blicatlons/eneatlaslatlas, as n. Q SITE AREq (ACRES) can be found �y viewing a Property Report using Pinpllas County'$ Public G15 Viewer available online at ht��is.vinellascountv.or�/public ttis/. Pl�nning & Developmant DepB��trnsr�t, 1pp 5. Myrtte qv�nue, Clearwa#er, FL 3375$, T'el: T7T•5fi2�b67; Fax: 727�562-4865 Page 3 of � F2evlsed �1/1S 01I30/2015 13:10 9493601491 THE UPS STORE 2950 PAGE 05� ��- 1 ° � ea��t�r V ATTENDANCE AT PUBUC HEARINGS Paanning & Developrnen# Deparcrn;ent Pet�tion for Annexat�ion �x�farmat�ar� for ,Applic�ants The applicant or �pplicant's representative is encouraged to attend City Countil public hearings unless the annexation pertains to � property deve(Qped or to be developed with one single family dwelling. STq,MDARDS FQR ANN�(ATION !n determiaing whether to annex d property, the City shall consider the extent to whi[h: 0 The proposed annexation wilt impact public servites (e.g., water, sewer, polite, parks, etc.}. � The proposed annexatlon is �onsistent with the City of Clearwater Comprehensive Plan. Cl The proposed annexation requires a change in the future tand use �nd zoning Cl�ssifications assigned to the property as well as the jurisdittion for said �hange. � Existing or prnppsed development is consistent with City regulations. ❑ Terms of a proposed AnnexBtion Agreement, if any, promotes the City of Clearwater Comprehensive Plon. PtiOPEKTY QWNER AGREEMENT Please be attvised that, in �onsiderati4n Of #he annexation, the property owners do hereby agree that- ❑ AI! structures and impravernents whf�h dre erected upon said property subsequent to the date of this petition for an�sexdti0� shall COrrt�7ly w�th all appiicable Ci�y �f Zieanvater regulations and ordinances as set forth in the C'rty Code of brdlnances; i� All residential rental units, including single-family residences must comply with the requirements in the city�s residential rental ordinance, whi�h requires the property owner to obtain a Business Tax Receipt upon ann�xetion into the cfty; ❑ If de�elOpment is to be ini#iated prior ta submission of an annexation petition and/or prior to the effecti�e date of the dnnexation, requisite site pl�ns, plat, and engineering plans shall be submitted to ensure compliance with the cRy'S Community Development Code (see Submittat Package Instruct}pns Checklist). !t is recommended th�t the applican# meet with Planning and Development Department staff t4 review pians and/or discus5;he �pplicable tity regulations; D All annexations of residential dwellings of eight dwelling units or more shali tonvey such retre2tion facitities fees and retreation land dedicatipn and/or fees in the �mount and manner prescribed by Chapter 54, Arti�le II of Clearwater Code of brdinantes; and 0 When �ny substandard abutting street or utilities are subsequentiy upgraded by the City to meet City 5#andards, said improvement(s► will be dane on an assessment basis, tonsistent with C'rty pracedures therefor�. Planning & D�vetopmerrt DepaRment, t00 S. IAyrtle A+renue, Clearwater, F� 33766, TeI: )2T-462-d567; �8x: 727-582a1$Bfi Page 4 of 7 ReviBetl D7M 5 . 01/30/2015 13:10 9493601491 THE UPS STDRE 2950 PAGE 06 LL PIann�ng & Developmex�t Depa�rtment ° � ��i�at��r � , . _ �e�t�on for Annex�t�on U Disciosure Statennent PROPERTY OWNER (PER DEED): Todd Sand and )enni Meno-Sand MAI�ING ADDRESS: 26895 Aliso Creed Road, Ste 8-729, Aiiso Viejo, CA 92656-5301 PHQNE NUM6ER: (7pz} 528-6637 �MAIL• tsand[a�artis#i�edge.net AGEt�fi DR REPRESENTATtVE: �d �'��(�y MAILtNG ADDRESS: s �0 3 0 • , (a w �.ar � G ► " 'pii�,,•, I'�a* bo�r �= L '3 `•i (,1s"�i PHONE NUMBER: Z— ro S�--/Y EMAII: r�� (- o OTHER �'ERSONS HAYFNG ApY'� NAME: INTEREST I5: SP�CIFIC E NTER�ST NEtb: IN TME SUBJECT pRpPERTY: L7pk''S A ODM'RA�'1' EXfST FdR SALE Of TF1E SUBJ�CT PROPEltTY? COiVTaAGT IS: PARiIES INVOLVED — NAME; NAME: _ ARE 7i1ER£ �IY UP710N5 TO PtiRC1�fA5E #HE SUBJECT PRUPER'TY? PARTIES IlV+JQLVFp — NAME: NAM E: �� tHf� aav n�c��ES o� u�NS o�u TwF su�r�cr �a�arr� PARTIES lNVOLV�D — NAME: NA►ME: YES PHONE Ni1MBER: PHONE NUMBER: YES PFIONE NUMBER: PHbNE NUMBER: YES PHON� NUMBER: PHONE NUMBER: � NQ � ND � NO STATE Q� FLORIDA, COUNTY OF PINELLAS I{wej, th2 undersigned, acknowledge that all representations made in this appiication are true and accurate to the best of my knowlectge and authorize City representatives ta visit and photograph the property described ln this application. Sworn to and subscribed before me this � a'1�'` day of �I._. rb ^'' a � � �-�01 � by �� t�r �� i`'It ��t+�� who is pers�naily known/ha5 � produced � t�� S i�; �,,� � as identification_ Sign2ture af re of owner or representative � owner,dr representati�e Notary public, � My commission expir : �� -$�t �� Pianning 8� Devefopmettt Deparfinettt, 1q4 S. Myrtle Avenue, ClearwaLe►, FL 33756, iel: 727-662�1.587; Fdx: 727-582-d�BB Page 5 ot 7 Revised Dil'16 . 01/30/2015 13:10 9493601491 THE UPS STORE 2950 PAGE 07 LL ° � ��r�a��r � Affidav�t to .Aut�xoriz� Agex�t/Representative Plaan��tg & Development Departme�nt Petaitian for Annexat�on 1. Provide names of ail property owners on deed — PRINT full names: Todd Sand Jenni Meno-5and 2. That (I am/we arej the owner{s) and record title holder(s) of the following described property: 2063 North Betty lane, Ciearwater, F!. 33755 3. That this property constitutes the property for which a request for (describe requestj: Annexation in order to receive splid waste and sanit�ry sewer setvice from ihe �ty. 4. That the undersigned (hasJhav�) appointed and jdoe5/do} appoint: as (his/their} ) to �xecute any peti#ions or other documents necessary to affect such petiti�n; 5. That this affidavit has been executed to induce the City of Clearwater, Florida to consider and act on the above described praperty; 6. That site �isits to the property are necessary by City representatives in order to process this application and the owner authorizes City representatives to visit and photQgraph the property described in this application; 7. That (I/we), the undersigned authority, hereby certify that the foregoing is t Todd 5and r'� Jenni Meno-Sand Property Owner Property Owner a corre Owner rty Own .. � STATE pF F{9t�IBq, C�UNTY OF�IMEEkpt6 � � o ra�� BEFORE ME TWE UNpERSIGNEp, AN OFFICER DULY COMMI5510NED BY THE LAWS OF THE STATE OF f�8f�}BA, QN TNIS � ��' DAY qF �G.... � -'" . .i ��_, _ � � PERSONALLY APPEARED WHQ HAVING BEEN FIRST pl1LYSWORN DEP�SED AND 5AY5 THAT HE/5H� FULLY UNpERSTANpS THE CQNTENTS OF THE �F IpA T THAT HE/SHE SIGNED. $E�1'P�iRON� Coawal�rl0n !I� �! Monry Pu� • CWlomi�► �� No M Comm. �, ka J�n 8 20i� Nat�ry re My Commission Expires� � t _ � - � � Planning �[}erebpmertt QQpaltment,100 S. Myrde Avenue, Glearwater, F�. 337g6, Tef: 727-662�5B7; Fax: 727-b62-4BB5 Page 6 of 7 Revised 01115 01/30I2015 13:10• 9493601491 THE UPS STORE 2950 PAGE 08 � ° � ear�v�� P��nning & DeveIopment Depa,irtme�# Petit�on far A,nnexa�ion Supplemental Statement PROPEFtTY OWNER (pER pEED�: Tattd Sand and 1�nni Menv-Sand MAII.ING ApDRESS- 26895 Aliso Creek Rnad, Sie B-7a9, Aliso Vie)o, CA 92656-5301 CfTY QF tIEARWATEFi CASE NtIwIBER: r/we, `TOdd Sand and lenni Meno-Sand [insert names of all property owners], having fited a Petition fpr An�exation regarrling the above property/case number, g�ant tonsent, agree and atknowledge that the City of Clearwater may immediate�y or at a later time process the application to c�mpletion, incfuding adoption and recordation of related �rdinances, without ihe necessity to further notice me/us. This Supplemental5tatement shail supersede any provision in �ny Agreemen# to Annex executed by me/us or my/bur predecessors in interest. I/we further agree and acknowledge th�t I/we shall not restind the Petition for Annexation or execute any documents attempting such res�ission, and th�t any attempted restission shall be of np force drld effeCt. STA7E OF F�ORIDA, COUNTY OF PINELLAS 1(we}, the undersigned, acknowtedge that afl representations made in this application are true and accurate to the best of my knowledge and authorize �ty representatives to vis;t and photograph the property descrlbed in ihis application. Sworn t� and subs�r;bet! before me this �'��^ day of �c.c -Y _. �-�_� by �� ' � `� �""-� � • ��+ •.M� �a � �.�, who is personaily known/has Signature pf prop representative of entity) af (individual or autharized n, partnership or other own produced r :_ - � �- � ��_ as identif,cation. Notary public, My comrnissfon �� 8E11M PEiRONE ComnNaion # 20�i IIOW'y P1lolie - C�Y�art�h �� Ju�rt 8 20t8 + PManning � Development pepprtrr�er�t, 100 S. Myrtle Avenue, Claan,,,ater, F� 33756, Tel: 727-5fi2-4567; Fax: 727-SG2-4g$8 Ppge 7 pf 7 Reviged p1/15 I#: 2005486887 BK: 14787 PG: 2092, 12/08/2005 at 07:50 AM, RECORDING 2 PAGES $18.50 D DOC STAMP COI,LECTION $595.00 KEN BURKE, CLERK OF COURT PINELLAS �OUNTY, FL BY DEPUTY CLERK: CLKDM04 � � � w�rr o�n MDNID. TO MDND. R6lUfi1 �: (2�ICI06@ SEIf-2dd(CSS�(13�2�1'IDC� CM�O�E) Name: CHICAGO TTRE INSURANCE COAAPANY - SEM At6r�: Rian Haa9 Add�s: 10863 PARK BLVD. SUfTE d, Sertwrwie, Florida 33772 Fle Number. 05-427-OB ITHa Irotrurr�nt Prepared bK Name: CHICAGOTR�EINSURANCECOA�ANY-SEM AW: Nddress: Rian Haag 10663 PARK BLVD. surrE a, semino�e, Fbrida 33n2 ProP�-'�H APD�s Parcel l�ntifi�ation Foko Numba(s): 03I29I�Sd12060/00810050 Grantea(s) S.S. A (s) ., �� i, �� _ �� __- + � -�` � > � � .. i� � , � �� i -_ � �� -_ _ � ,� - � � � �� _-' � SPACE ABOVE TNIS LIHE FOR PHOCESSM�IG DATA S�,�C6ABOVE T}pS �INE FOR RECORDNG DATA �� ` � � � � \ � . �` �`' / . T�11S Wai'1'a�tj' DeeC�, Made and �xecured�tius �Vov¢hiber � 2005 ,-_ , _ �,_, by ALAN MfCHAEL KAY a single mary `whose addi�ess' is 340 Causeway Boulevc�d Unit 208 Dunedin, F[orida 34698 ` ` ' ' ,, - � hereinafter called the Grantor, to iOD� SAIVD and ,lEi�flV( tulthlfli,3AND,'bUSband and wife� whase post o�ce adca�ess is 763 ttarracuda ►ti'ay Laguna Beach,. California 92651 �� hereinafter called the Grantee_ (we«ever �.sea naein ux um�s ° Gr+�t«" md�° Gm�ee^ incnde au mc pars�s to mis u.shwnw eoa me neirs, kgal �epres�t�va, �a a�v�u or indiviauah, a�,a 1Lt �xxcors atd assi� pi y6'Ponbbu.S whcavtrJbt cuNna so adnits or ruprires) i i .. Witnes�Eth�'�'hat the �jrpnlor, for and in coruideration of the sum of a10.00 (Ten and 00/100 Dollars) and other valuable consi�er,atirins,, receifit'whereof is hereby acbrowledgec� hereby grants, bargains, sells, aliens, remises, releases, comeys and con)`'u�ms un�a the�Grantee, all that certain land, situate in Pinellas County, State of Florida, viz: The'Sgut�i 4Q�eertvf �ot 5 and North 10 feet of Lot 6, Block F, BROOKLAWN, according to plat thereof as recorded in PlakBoo�C 1'3,,Page(s) 59, of the Public Records of Pinellas County, Ftorida. ,\ , , ., , Together, with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. To Have a�td to Hold the same in fee simple forever. 1 of PINELLAS'COUNTY FL OFF. REC. BK 14787 PG 2093 wwRwwMrr o�� INDMO. TO INDMD. .� � � � � � � _ � � --_� � SPACE A80NE THIS LWE FOR RECORDING DATA .` `, `> i � And the Grantor hereby covenants with said Grantee that the Grarrtor is Imvfully seized of said lpn� m fee simple; that the Grantor has good righl and lawful authority to selJ and comey said Jand,• and hereby warrants7be t�r/e to said la»d and will defend the same against the lawful claims of al! persons whomsoever; and lhat said�lq� is )�ree of all encumbrances, except tares accruing subsequent to December 31, 2004. �' '� ,� �, In Witness Whereof, the said Grantor has signed and sealed these presen�s,zhe day andyear f`irst above wriner� � , ; , � �� , k Wi ' MI L KAY ,� ,' _ Pr' edn e `�� ' _ ., � �. � ,, ,( .L� � r%c . � � ` \ Printed name � - �. _ ` ,�,' �� , � �� --� .� STATE OF FLORIDA COUNTY OF ,� � � �'�� This fo2going instrumeM was aeknbwled(�ed betore me this No�rember ��, 2005, by ALAN MICHAEL KAY. (Chedc one:) oSaid person(s) is/are persona�yi kaoMm t4 me_ 6ZJ Said Pe►son(s) provided the fodowing type oT ide�tion: VaNd Drivers License rrornRV �(uee� srnnqP',sEO,i, ,� � , � • FWIC �, . � J1eWY PuDie-SI�MdFloAO� ' -Co�M�n E�YM Ju111. 200Y CaM11�bn 1 DD �16011 PriM r�arr�e 8aid�d Bp NworW NolryAun. . �, � �, 2 or r , ° C earwater U �„`� P -s,.,m..."' 1. r 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 6 COMPLETE SETS OF APPLICATION AND SUPPLEMENTAL MATERIALS (1 ORIGINAL AND 5 COPIES) AS REQUIRED WITHIN ARE TO BE SUBMITTED FOR REVIEW BY THE DEVELOPMENT REVIEW COMMITfEE. 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: SD IMPACT FEE/ASSESSMENT FEE: TBD Information on Impact Fees orAssessment Fees rs available from the City of Clearwater Engineering Department (562-4747). PROPERTY OWNER (PER DEED): Linda J. Bauman MAILING ADDRESS: 1226 Aloha Lane, Clearwater, FL 33755 PNONE NUMBER: 727-466-0393 EMAIL: linnbauman@gmail.com AGENT OR REPRESENTATIVE: MAIUNG ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBIECT PROPERTY: PARCEL NUMBER(S): 1226 Aloha Lane 03-29-15-87912-003-0070 LEGAL DESCRIPTION: �ot 7, Block 3, Sunset Knoll CURRENT CITYSERVICES: SANITARY SEWER REQUESTEDCITYSERVlCES: X SANITARYSEWER (select all that applyJ SOLID WASTE x x SOLID WASTE WATER Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 1 of 7 Revised 01115 � ° C earwater rv�� . �� . 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 APPUCATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY): Residential Urban (RU) REQUESTED (CITY): Residential Urban (RU) ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): SITE AREA: 0.164 SIZE OF DEVELOPMENT : Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residentia! square footage) R-4, One, Two, and Three Family Residential Low Medium Density Residential (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 Single Family n/a Y 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 l�� day of .--- ,^ �A�;v,a�y , 2�f; .by ' � L r,v t�� Ptt�ri.t,�1,J , who is ersonally know /has t j � !/ ��,�,��' � . �� produced as identification. Si�nature r o representative Notary public, My commission expires: Signature of property owner or representative r �� v � A�ICFUIEL VENEZIA ST/17'E OF F10R1DA c.,..�.�s ��303 Expires 3I4/2018 Planning & Development Department, 100 S. Myrt1e Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 2 of 7 Revised 01/15 ° earwater Planning& Development Department > V .w..,ti o, � ,,.4,., Petition for Annexation U r�=,°. ,� -,..'- �'�° -';'.wJ Submittal Package Instructions & Checklist IN ADDITION TO THE COMPLETED ANNEXATION PETITION FORM, ALL PETITION FOR ANNEXATION PACKAGES SHALL INCLUDE A SUBMITTAL PACKAGE THAT INCLUDES THE FOLLOWING: ❑ Signed and sworn (notarized) disclosure of interest statement (form attached). ❑ If the property is not a platted lot of record, a current survey identifying the dimensions, area and location of the property having been prepared, signed and sealed by a land surveyor currently registered in the State of Florida within the most recent 12 months. [Note: Submit two copies only] 0 If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plat, and engineering plans. ❑ Terms of a proposed Agreement to Annex, if any. ❑ If the proposed annexation requires a change in the land use classification and zoning category assigned to the property, a justification for such change must be submitted in writing. If the requested zoning is not consistent with the Future Land Use Map of the City of Clearwater Comprehensive Plan, the applicant will be required to file a companion application to amend the map. ❑ Proof of ownership (e.g., copy of deed, title insurance policy, or other instrument demonstrating ownership). [Note: Submit two copies onlyj ❑ If connection to city services is desired prior to the effective date of the annexation, applicant must provide notarized Petition for Annexation Supplemental Statement (form attached). [Note: Submit original only] ❑ If applicant is designating an agent/representative to work with City, applicant must provide notarized Affidavit to Authorize Agent/Representative (form attached). [Note: Submit origina! only] INFORMATION REQUIRED TO COMPLETE THE PETITION FOR ANNEXATION APPLICATION AND DATA SHEET CAN BE FOUND ON THE FOLLOWING DOCUMENTS AND/OR ONLINE AT THE FOLLOWING WEBSITES. IF THE APPLICANT IS UNCERTAIN WHERE TO LOCATE THIS INFORMATION OR NEEDS ADDITIONAL ASSISTANCE, PLEASE CONTACT THE PLANNING AND DEVELOPMENT DEPARTMENT, LONG RANGE PLANNING DIVISION AT 727-562-4567. ❑ PARCEL NUMBER (Parcel I.D. Number) can be found on the Warranty Deed. It can also be found by searching the Pinellas County Property Appraiser's Office website at www.pcpao.org (search database by address). 0 LEGAL DESCRIPTION can be found on the Warranty Deed. It can also be found by viewing the property record online at the Pinellas County Property Appraiser's Office website at www.pcpao.or�. 0 FUTURE LAND USE PLAN DES�GNATION (COUNTY) can be found by viewing a Property Report using Pinetlas County's Public GIS Viewer available online at http://�is.pinellascountv.or�/public gis/. Search by property address or Parcel I.D. Number and report will appear. ❑ FUTURE LAND USE PLAN DESIGNATION (CITY) is typically the same as the land use designation in Pinellas County, unless applicant is proposing a change (see submittal package requirements for more information). ❑ ZONING DISTRICT (COUNTY) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://�is.pinellascounty.or�/public gis/. 0 ZONING DISTRICT (CITY) can be found by contacting the Planning and Development Department or viewing the City's Zoning Atlas, available online at http://www•myclearwater.com/�ov/depts/pwa/en�in/publications/en�atlas/atlas.asp. ❑ SITE AREA (ACRES) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://�is.pinellascounty.or�/public gis/. Planning 8 Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 3 of 7 Revised 01115 m ° 1 rwater ��ea `�-, � -° e,.�,�-° "-. r:"'� .�``, � , �..''.-,, • ATTENDANCE AT PUBLIC HEARINGS Planning & Development Department Petition for Annexation Information for Applicants The applicant or applicant's representative is encouraged to attend City Council public hearings unless the annexation pertains to a property developed or to be developed with one single family dwelling. STANDARDS FOR ANNEXATION In determining whether to annex a property, the City shall consider the extent to which: ❑ The proposed annexation will impact public services (e.g., water, sewer, police, parks, etc.). ❑ The proposed annexation is consistent with the City of Clearwater Comprehensive Plan. ❑ The proposed annexation requires a change in the future land use and zoning classifications assigned to the property as well as the jurisdiction for said change. ❑ Existing or proposed development is consistent with City regulations. ❑ Terms of a proposed Annexation Agreement, if any, promotes the City of Clearwater Comprehensive Plan. PROPERTY OWNER AGREEMENT Please be advised that, in consideration of the annexation, the property owners do hereby agree that: ❑ All structures and improvements which are erected upon said property subsequent to the date of this petition for annexation shall comply with all applicable City of Clearwater regulations and ordinances as set forth in the City Ccde of �rdinances; ❑ All residential rentai units, including single-family residences must comply with the requirements in the city's residential rental ordinance, which requires the property owner to obtain a Business Tax Receipt upon annexation into the city; ❑ If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plat, and engineering plans shall be submitted to ensure compliance with the city's Community Development Code (see Submittal Package Instructions Checklist). It is recommended that the applicant meet with Planning and Development Department staff to review plans and/or discuss the applicable city regulations; ❑ All annexations of residential dwellings of eight dwelling units or more shall convey such recreation facilities fees and recreation land dedication and/or fees in the amount and manner prescribed by Chapter 54, Article II of Clearwater Code of Ordinances; and 0 When any substandard abutting street or utilities are subsequently upgraded by the City to meet City Standards, said improvement(s) will be done on an assessment basis, consistent with City procedures therefore. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 4 of 7 Revised 01/15 � f ° C ear�vater c, ��, .r` �;�.m�,�;.°:;;��-�.;: ._.. ..� -.,�,".�""0..3'°� u.� �>�,�'` PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRE55: PHONE NUMBER: EMAIL: Linda J. Bauman 1226 Aloha Lane, Clearwater, FL 33755 727-466-0393 linnbauman@gmail.com Planning & Development Department Petition for Annexation Disclosure Statement OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SAIE OF THE SUBIECT PROPERTY? CONTRACT IS: PARTIES INVOLVED — NAME: NAME: ARE THERE ANY OPTIONS TO PURCHASE THE SUBIECT PROPERTY? PARTIES INVOLVED— NAME: NAME: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBIECT PROPERTY? PARTIES INVOLVED—NAME: Cenlar NAME: YES x PHONE NUMBER: PHONE NUMBER: YES x PHONE NUMBER: PHONE NUMBER: x YES [�[�7 NO NO PHONE NUMBER: 1-800-223-6527 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 �'�i1-� day of _ , (a..��r'k2� , Z.DI S° . by _ _ i ' �.l s� ��A �dl �J .M r1,tJ , who is ersonally know�n/has � ��_____ _. _= „�.�„� produced as identification. of property�wr�er or representative Signature of property owner or representative � Notary public, My commission expires: MI�FiAEI VENE� NOTAI?1� PUBIIC Ccmrn� FFp98303 r Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 5 of 7 Revised 01115 . ° ear�water � V � � Planning & Development Department Petition for Annexation Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed — PRINT full names: Linda J. Bauman 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 1226 Aloha Lane 3. That this property constitutes the property for which a request for (describe request): Annexation in order to receive solid waste and sanitary sewer service. 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 application; 7. That (I/we), the undersigned authority, hereby certify that the foregoing is true and correct. linda 1. Bauman 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 HAVING BEEN FIRST DULY SWORN DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Seal/Stamp Notary Public Signature My Commission Expires: Planning & Development Department, 100 S. Myrtie Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 6 of 7 Revised 01/15 ° earwater �C PROPERTY OWNER (PER DEED): Linda 1. Bauman MAILING ADDRESS: 1226 Aloha Lane, Clearwater, FL 33755 CITY OF CLEARWATER CASE NUMBER: Planning & Development Department Petition for Annexation Sunplemental Statement I/we, _Linda J. Bauman [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 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 representative of corporation, partnership or other entity) Notary public, My commission expires: Signature of co-property owner . �y who is personally known/has as identification. P�anning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 7 of 7 Revised 01115 #: 2004402�74 BK: 13881 PG: 874, 10/12/2004 at 04:11 PM, RECORDING 1 PAGES 10.00 KARLEEN F. DE BLAKER, CLERK OF COURT PINELLAS COUNTY, FL BY DEPUTY [,ERK: CLKDMCl This instrum�nt wai prcpared Dy: Aose Marie W'6oe Fbrids Aa�nily Document Prepantioe Scrvkes, lnc 12041A 66� Strat NoAh Largo� Fbrida 33773 Pkau Return ro: LWDAJ.BAUMAN 1226ALOHA LANE CLEARWATER, YL 33155 Grache SS Nw - Rec S Doc SL S Property APpniscr's Parce) Idc»li�ication Na QUIT-CLAIM DEED i� i� „ ,, T'gIg QUIT-CLAIM DEED, Executed this 15th day of June 2004, by Leonard W. Baum�Y,� "` _: Jr., a married man, first party(s), to Linda J. Bauman, a married woman, who resides at 1226 Alqh� ;`, Lane, Clearwater, FL. 33755, second party, hereinafter called the Grantee. `` '' . . � , WI7'NESSETA, That the said first party, for and in consideration of the sum of $10.00 in �-- hand paid by the said second party, the receipt whereof is hereby acknow]edged, d9es hereby remise, release and quitclaim unto the said second party(s) forever, all the right, title, interest,`qlaim and demand which the said firsi pazty has in and to the following described lot, piece or p�rFel of lapd, � situate, }ying and being in the Courny of Pinellas, State of Florida to-wit: �� ,;�� '� � alDesc ' t�og: � � ' `' \ � Lo Seven (7), Block 'Three (3), SiJNSET KNOLL SUBDIVIS'IQN, accbfciing to the map or plat thereof, as recorded in Plat Book 24, Page 26, Public Records of �i�el�as C�p4nty, Florida. � ` , TO HAVE AND TO HOLD the same together with,ajT and singul�r ihe �appurtenances thereonto belonging or in anywise appertaining, and al] the �state, right,'tiNe, interest, lien, equity and claim whatsoever of the said first parties, either in law, or eqaity2 to the only proper use, benefit and behoof of the said second parties forever. This is the haoiesteaci �xo.pe�c of the Grantee. Title to the real property, at the request of the parties to the garisactiori; has t�et,and will not be examined. iN �Vi'IiYESS `rV��it3F, Tt�e sai'li fitst gatiy�sj hav�,3i�nec3 and �led these presenes tne day and year first above written. ' Signed, sealed and deliver our Pi@sence, �'. As witness�s: . . Wih�css #1 �' �' �. Lb:O ARD W. B lJMAN, JR. � � ` � 7� MARRIED MAN CHAUNCEY PEMX � ;' 13520 BINGLEWOOD AVE , ,� SEMINOLE, FL 33776 TE NAME OF _ _ , Wltriess � �T � ' ROSE MAF,23E SLO�J VJILSO?�i- `% PRINI'ED NAM OiYYI `. fiSS � S1`'Q'1'E OF `FLOTtIDtY� CO17D1Tj' OFPiN,'EELLAS �"Fhe�oregding instrume as acknowledged before on this 15`" day of June 2004 by LEONARU�. BAUMAN> > a man- ^ � wrllvESS my haz,a u,a offic;al seal. Rose Marie Sloan Wilson My commission e�tpi�cs: August Personelly Known OR Produced Identificalion x Type of Identification Produced: A Florida Driver's Licznse. .� � � � � � � __ �� --_� , -.` .1 > i `` `` .. „ „ .,