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ANX2015-030062125 BURNICE DR ANX2015-03006 Kane, William V and Marlyce T Zoning: Low Medium Density Re Atlas #: 308B � vavs�.� ....�..� U Flanning & 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 S COPIES) AS REQUIRED WITHIN ARE TO BE SUBMITTED FOR REVIEW BY THE DEVELOPMENT REVIEW COMMITTEE. APPLICATIONS AND SUPPLEMENTAL MATERIALS ARE REQUIRED TO BE COLLATED AND STAPLED INTO SETS. IT IS INCUMBENT UPON THE APPLICANT TO SUBMIT COMPLETE AND CORRECT INFORMATION. ANY MISLEADING, DECEPTIVE, INCOMPLETE OR INCORRECT INFORMATION MAY INVALIDATE YOUR APPLICATION. THE APPLICANT, BY FILING THIS APPLICATION, AGREES TO COMPLY WITH ALL APPLICABLE REQUIREMENTS OF THE CUMMUNITY DEVELOPMENT CODE. APPLICATION FEE: $0 IMPACT FEE/ASSESSMENT FEE: TBD lnformation on Impact Fees orAssessment Fees is available from the City of Clearwater Engineering Department (562-4747). PROPERTY OWNER (PER DEED): Barry and Lisa M. Pack MAILING ADDRESS: 2131 Burnice Drive, Clearwater, FL 33764 PHONE NUMBER: EMAIL: barrybpack@hotmail.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: 2131 Burnice Drive PARCEL NUMBER(S): 24-29-15-31050-000-0230 LEGAL DESCRIPTION: Glen Ellyn Estates Lot 23 CURRENT CITY SERVICES: REQUESTED CITY SERVICES: x (select all that apply) SANITARY SEWER SANITARY SEWER 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 01/15 0 � � earwate� 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 BEIN6 FOUND INCOMPLETE AND POSSIBLY DEFERRED UNTIL THE FOLLOWING APPLICATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY): Residential Low (RL) REQUESTED (CITY): Residential Low (RL) ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): SITE AREA: 0.236 SIZE OF DEVELOPMENT : Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residential square footageJ R-3, Single 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 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.d Sworn to and subscribed before me this 1 day of � �� bV :il°� ��ty7'�% �C�G�- — �.a`�'� (11� .�1� , who is personally known/has '� ` J f�` � prod�ed �'A��110��.C� as identification. Signature o�roperty owner or representative �- ��, c�, i�. �c�c..� Signature of property owner or representative Notary Y My commission expires: � �4 ; �01� �.�'a �`� Notary Pt�Dlic, Stato Of f�otlda CommlSSia�tr� FF 94553 �+ c�amsn, expfre� Feb. 2Q, �018 Planning 8 Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 2 of 7 Revised 01/15 LL ° � earwat�r 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 Barry and Lisa M. Pack 2131 Burnice Drive, Clearwater, FL 33764 barrybpack@hotmail.com OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBIECT PROPERTY? CONTRACT IS: PARTIES INVOLVED — NAME: NAME: ARE THERE ANY OPTIONS TO PURCHASE THE SUBIECT PROPERTY? PARTIES INVOLVED — NAME: NAME: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBIECT PROPERTY? PARTIES INVOLVED — NAME: NAME: YES PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: NO NO NO STATE OF FLORIDA, COUNTY OF PINELLAS I(we}, the undersigned, acknowledge that ali 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 n. Sworn to and subscribed before me this day of � ✓�!n 2� �' . by �_�i i��C.G�c[ L�`{�tdl�l ��. , who is personally known/has produced �(��/�J' 1 .-=w�t— asidentification. re of p�fop'�rty owner or representative 4/ �..�i�:.� � � �C'.�C'.�- Signature of property owner or representative Nota�fy public°, �, My commission expires: Notary Public, StaW Comtnlssbn� FF y cpmm. explrss F� Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562� , . Page 5 of 7 Revised 01/15 2019 LL ° C earwat�r Planning & Development Department Petition for Annexation � Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed — PRINT full names: Barry Pack Lisa M. Pack 2. That (f am/we are) the owner(s) and record title holder(s) of the following described property: 2131 Burnice Drive, Clearwater, FL 33764 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 from the City. 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. Barry Pack Lisa M. Pack TH IS 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. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 6 of 7 Revised 01/15 LL ° � ear�vater Planning & Development Department Petition for Annexation � Supplemental Statement PROPERTY OWNER (PER DEED): Barry and Lisa M. Pack MAILING ADDRESS: 2131 Burnice Drive, Clearwater, FL 33764 CITY OF CLEARWATER CASE NUMBER: I/we, Barry and Lisa M. Pack [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 �n to and subscribed before me this � _ day of �l�-� . ��.� . by �'�,VY`I ��'� �-i�� I� ��%.i�-- who is personally known/has �� produced �((A� ODL�2¢�$ � � ' as identification. Sig►5ature ot roperty owne7rti�idividual or authorized representa ive of corporation, partnership or other entity) , c��' � �- (��. Signature of co-property owner Nefary public; / � My commission expires:��j 2�, 2� Notary Pubiic, Siate t� F!artda Co�mlasb� FF 94.�53 NSy c�mm. oxptras Fab. 2�, �Ot� Planning 8� Development Department, 100 S. Myrtle Avenue, Clearvvater, FL 33756, Tel: 727-562�3567; Fax: 727-562-4865 Page 7 of 7 Revised 01/15 Document Prepared By: Steve Q. Galiano ReconTrust Company 2575 W. Chandler Blvd. Mail Stop: CHDLR-C-88 Chandler AZ 85224 (800) 540-2684 BARRY PACK, LISA PACK 2131 Burnice Dr Clearwater, FL 33764 ��ti S � , ?' � � , KEN BURKE, CLERK OF COURT PINELLAS COUNTY FLORIDA INST# 2008269573 10/03/2008 at 11:29 AM OFF REC BK: 16393 PG: 714-714 DocType:S RECORDING: $10.00 UID:a22bff69-Odbe-4322-a901-661a8265f9a9 DOCI D_00057273222005N SATISFACTION OF MORTGAGE KNOW ALL MEN BY THESE PRESENTS: Mortgage Electronic Registration Systems, Inc. the owner and holder of a certain mortgage deed executed by BARRY PACK, LISA PACK bearing date 12/12/2002, recorded on 12/19/2002 in Official Records Book 12421, Page 1001 , Instrument # 2474670 in the office of the Clerk of the Circuit Court of PINELLAS County State of Florida, securing a certain note in the principal sum of 93000.00 Dollars, and certain promises and obligations set forth in said mortgage deed, upon the property situated in said State and County hereby acknowledge full payment and satisfaction of said note and mortgage deed, and surrenders the same as canceled, and hereby directs the Clerk of the said Circuit Court to cancel the same of record. (CORPORATE SEAL) ��°� ��'sr �, ;� . w ��a4iP0%{p7F.�� "' �. SI-;AI., , `�'��a ,ss9 s� � �*- �`a:Ak�s� � . y � �+anac,rs�oy� �Ic ATTEST: Kimberly Robertson Assistant Secretary IN WITNESS WHEREOF the said Corporation has caused these presents to be executed in its name, and its corporate seal to be hereunto affixed, by its proper officers thereunto duly authorized, the 23 day of September, 2008. Signed and delivered in the presence of: Mortgage Electronic Registration Systems, Inc. 2125 BURNICE DR ANX2015-03006 Kane, William V and Marlyce T Zoning: Low Medium Density Re Atlas #: 308B � ----- - • -- - -- 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 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 COMMITTEE. APPLICATIONS AND SUPPLEMENTAL MATERIALS ARE REQUIRED TO BE COLLATED AND STAPLED INTO SETS. IT IS INCUMBENT UPON THE APPLICANT TO SUBMIT COMPLETE AND CORRECT INFORMATION. ANY MISLEADING, DECEPTIVE, INCOMPLETE OR INCORRECT INFORMATION MAY INVALIDATE YOUR APPLICATION. THE APPLICANT, BY FILING THIS APPLICATION, AGREES TO COMPLY WITH ALL APPLICABLE REQUIREMENTS OF THE COMMUNITY DEVELOPMENT CODE. APPLICATION FEE: $0 IMPACT FEEjASSESSMENT FEE: TBD Information on Impact Fees orAssessment Fees is available from the City of Clearwater Engineering Department (562-4747). PROPERTY OWNER (PER DEED): William V. and Marlyce T. Kane MAILING ADDRESS: 2125 Burnice Drive, Ciearwater, FL 33764 PHONE NUMBER: %� 7, � 1,L �— a'� L{ � EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: 2125 Burnice Drive PARCEL NUMBER(S): 24-29-15-31050-000-0220 LEGAL DESCRIPTION: Glen Ellyn Estates Lot 22 CURRENT CITYSERVICES: REQUESTEDCITYSERVICES: x (select all that applyJ SANITARY SEWER SANITARY SEWER SOLID WASTE x x SOLID WASTE WATER Pianning S Development Department, 700 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 1 of 7 Revised 01/75 � LL ° C earwater 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 THE FOLLOWING APPLICATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY): Residential Low (RL) REQUESTED (CITY): Residential Low (RL) ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): SITE AREA: 0.236 SIZE OF DEVELOPMENT : Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residentiol square footage) R-3, Single 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) re nta I? Single Family Single Family n/a 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 �4�'" day of �'.ss.Pc7�u.tCi.c-�. :�t;�l� . by lJ�%�<<( Ck�l �IA,+�.f�-1i�t�(i/CQ �� who is personally k_,nown/has /�� S y�/ �j�� produced —��-�°—F- as identification. Signature of property owner Q'r representative � Q_ � 1 �-�. owner or representative �4�t.� �"�n Notary public, My commission expires: �, ° �— r1- (� (� � �' Lisa M Padc . y, My Commission FF 155222 � °OO� � Explros 09f0912018 _ Planning 8� Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562�4567; Fax: 727-562-4865 Page 2 of 7 Revised 01/15 LL ° � earwater � PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: Planning & Development Department Petition for Annexation William V. and Marlyce T. Kane 2125 Burnice Drive, Ciearwater, FL 33764 ��i— L!z-1� — 03 y� OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBIECT PROPERTY: NAME: INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? CONTRACT IS: PARTIES INVOLVED — NAME: NAME: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? PARTIES INVOLVED — NAME: NAME: Disclosure Statement _ YES X NO PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: ARE THERE ANY ORTGAGES O LIENS ON TNE SUBJECT PROPERTY? � YE /J r PARTIES INVOLVED— NAME: �!QCi�:�1,�-� i��C2.M-�-- PHONE NUMBER: NAME: PHONE NUMBER: _� NO 7< NO �7��1-'�� (� - c�� — 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 applica,tijon Sworn to and subscribed before me this �`-[ � day of --7".p>�_Y�.�.L (k�t�� ( % 15 _ by ��t`�'C+k1� �t+� ��i�✓��(P ��uho is personally known/has �� f� /j��/ produced y � as identification. property or�vner or representative � • C�GZC:�� Notary public, V .Q �� My commission expires: �—�T' a� �re of property o ner or repres tative � Planning � Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562 ' Page 5 of 7 Public S1a� of My Commission FF . na�na/2ot8 LL ° C earwater Planning & Development Department Petition for Annexation � Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed — PRINT full names: William V. Kane Mariyce T. Kane 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 2125 Burnice Drive, Clearwater, FL 33764 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 from the City. 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. William V. Kane Marlyce T. Kane 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. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 6 of 7 � Revised 01/15 . . LL ° � �arwat�r U PROPERTY OWNER (PER DEED): William V. and Marlyce T. Kane Planning & Development Department Petition for Annexation Sunplemental Statement MAILING ADDRESS: 2125 Burnice Drive, Clearwater, FL 33764 CITY OF CLEARWATER CASE NUMBER: I/we, William V. and Marlyce T. Kane [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 applic�t,ip� Sworn to and subscribed before me this �`f day of Signature of propert�Yowner (individual or authorized representative of corporation, partnership or other entity) Signature 25flFo-property F��t.c.z� � `_f ��+s . bv �`''��a`�L ��- ��'��/� 1��, who is personally known/has produced ✓ �� - Y\1 < P�.C.�.� Notary public, My commission expires: � " � "� � � Lifa M Padc My Comn+�ssk t' �� I�y N(�ry r�.....� --- ',..>n . � � M Padc "- , r.,�, . ,,:,,r:��,;on F� 155422 . �� '��:i.i,.., . i t q � .. : � `' : w�� w�� 1/'�\! hF _^~�� SI M r �/ M as identification. Planning 8� Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 7 of 7 Revised 01/15