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ANX2016-030120 arwamr U 2100 BURNICE DR ANX2016-03012 Belcher Area Multiple Properties Zoning: Low Medium Density Re Atlas #: 308B 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. ALL PAGES WITHIN MUST BE SIGNED BY ALL PROPERTY OWNERS LISTED ON THE DEED. 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 FEE/ASSESSMENT FEE: TBD Information on Impact Fees or Assessment Fees is available from the City of Clearwater Engineering Department (562-4747). To Be Completed By City of Clearwater: TYPE OF ANNEXATION: x CONTIGUOUS NONCONTIGUOUS (TYPE A ENCLAVE) To Be Completed By Property Owner: PROPERTY OWNER (PER DEED): Jeff A. Harrison MAILING ADDRESS: 2100 Burnice Drive, Clearwater, FL 33764 PHONE NUMBER: 727-798-9788 EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: 2100 Burnice Drive, Clearwater 33764 PARCEL NUMBER(S): 24-29-15-31050-000-0160 LEGAL DESCRIPTION: Glen Ellen Estates Lots 16 and 17 and Vacated 30ft St West of Lot 17 CURRENT CITY SERVICES: SANITARY SEWER SOLID WASTE WATER REQUESTED CITY SERVICES: x SANITARY SEWER x SOLID WASTE (select all that apply) Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 1 of 7 Revised 04115 LL if _}+ arwater a, 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): R-3 Single Family Residential REQUESTED (CITY): Low Medium Density Residential (LMDR) SITE AREA: 0.506 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residential square footage) 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? ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? IF YES, PLEASE LIST/EXPLAIN: Single Family Single Family No YES ❑ 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 applicati-q-q. o Sworn to and subscribed before me this I (Tr day of ``�P `�� , by A �% p RAP-14%ori who is personally known/has v� re of property owner or representative Signature of property owner or Planning & Development Page 2 of 7 produced v ",)— A Notary publi, My commissi expires: �..Nl. ANDREWS,. E Notary ,Publics State of Florida I dfY§4glgttkJcplKeaiA 4 told" Gommiasior.FF 1.52160 A00 SON as identification. WA FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Revised 04/15 ° Clearwater 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: ❑ 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. City staff will review proposed plans to determine their compliance with the City's Community Development Code. ❑ 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 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 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). ❑ 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.org. ❑ 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://gis.pinellascounty.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). ❑ ZONING DISTRICT (COUNTY) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://gis.pinellascounty.org/public gis/. ❑ 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/gov/depts/r)wa/engin/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://gis.pinellascounty.org/public gis/. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-5624865 Page 3 of 7 Revised 04115 LL �� °_ C arwater U 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 Community Development Code; ❑ 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 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 ❑ 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 04/15 04 'Aearwater �_ 0 Planning & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Jeff A. Harrison MAILING ADDRESS: 2100 Burnice Drive, Clearwater, FL 33764 PHONE NUMBER: 727-798-9788 EMAIL: 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 SUBJ-ECT PROPERTY? YES NO CONTRACT IS: PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? YES NO PARTIES INVOLVED— NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? YES PARTIES INVOLVED — NAME: NAME: NO PHONE NUMBER: P60Z-- 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 applicatior�q Sworn to and subscribed before me this 1 I day of l U � e by 4>� AUfI V"4 who is personally known/has produced lD � VlOtl 1� U"J P � as identification. Sign a of property owner or representative / P A Notary public, My commissC/gfri/expires:� Signature of property owner or represe Planning 8 Development Departmen r'°e���° , Tel: 727-562-4567; Fax: 727-562-4865 Page 5of7 +_ epi 42 °~ Revised 04/15 , �%%,4fha••r . '! COmmltii0rl:'ill F— 152160 . o� Planning & Developmen epartment } C arwaterPetition for nexation Affidavit to Authorize Agent/Re esentative 1. Provide names of all property owners on deed —PRINT full names: Jeff A. Harrison 2. That (I am/we are) the owner(s) and record title holder(s) of the following descri ed property: 2100 Burnice Drive, Clearwater, FL 33764 3. That this property constitutes the property for which a request for (descri request): Annexation in order to receive solid waste and sanitary sewer service f m the City. 4. That the undersigned (has/have) appointed and (does/do) appoi 5. Q as (his/their) agent(s) to execute any petitions or other do That this affidavit has been executed to induce the City described property; dements necessary to affect such petition; Clearwater, Florida to consider and act on the above That site visits to the property are necessary by Cit representatives in order to process this application and the owner authorizes City representatives to visit and otograph the property described in this application; 7. That (1/we), the undersigned authority, here Jeff A. Harrison THIS Property Owner Property Owner rtify that the foregoing is true and correct. STATE OF FLORIDA, COUNTY OF PINELLAS Property Owner Property Owner BEFORE ME THE UNDERSI"ED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON OF PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND�AYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Public Signature Notary Seaf Stamp 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 04115 ° C earwat r e U PROPERTY OWNER (PER DEED): Jeff A. Harrison Planning & Development Department Petition for Annexation MAILING ADDRESS: 2100 Burnice Drive, Clearwater, FL 33764 CITY OF CLEARWATER CASE NUMBER: Supplemental Statement /we, _Jeff A. Harrison [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. Select One Option Below Which Applies to This Petition for Annexation: 9 Annexation of Contiguous Parcel(s): 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. ❑ Annexation of Noncontiguous Parcel(s): I/we understand that this annexation is voluntary, and that I/we may withdraw this Petition for Annexation prior to final action on this Petition by the City of Clearwater. I/we further agree and acknowledge, however, that receipt of all sewer, solid waste or other city service is contingent upon completion of the Petition for Annexation process, and that any withdrawal of this Petition prior to final action by the City, may result in a discontinuance and termination of all City -provided services. 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 11 rq day of (/� J produced r ature of property owner (individual or authorized r resentative of corporation, partnership or other entity) Notary PL My covfim Signature of co -property owner Comrr d 4NOREWS Notary -Public State bi flo My Comm: EftDlrefi' ii�nA- Planning & Page 7 of 7 2z6LD by who is personally known/has tc,A) as identification. on expire 116 FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Revised 04/15 PREPARED BY & JZeturn to: -Barbara J. Bylski LAWYERS'TITLt INSURANCE CORP ,2420 Enterprise Rd., #I107 Clearwater, FL 33763 (727) 712-8668 LTIC No. -:01-0" 11` 01-268959 AUG- 2-2001 3:22pn P TNEL 11tR CO BK 11509 PG 96 M111111110111�1i11�1E@gni U LAWYERS TITLE INSURANCE C O R P O R A T I O N I N D I V I D U A L D E E D KARLEEiI F. DE 1 am IF COURT PINFI.LAS COUNTY, FLURIDA 801001 OB -02-2001 15:21:51 YHW N 51 IED-GARCIA KATHY Z.i o 0000 I#:012hf1959 RK:11E�9 S%:0086 EpG:OX7 3o RECORDING 002 PAGES 1 $10.50 o n NM DOC STAMP - DR219 3 $997.50 CDW TOTAL: D v X CIf.CK Ahl.TENDERED: i CHANGE- $.00 , RY DEPUTY CLERK' _ - This Warranty Deed made on between Kathy Kinkle Garcia n/k/a Kathy Kinkle, a single person and Donald M. , Kinkle, a married person "- whose mailing address is: 2873 Sea Pines Circle west, Clearwater, Florida 33761 Hereinafter called the Grantor, and Jeff A. Harrison,gsinal,g f erson Whose mailing address is: 2100 Burnice Drive, Clearwater, Florida 3%3'j64_ Hereinafter called the Grantee, WITNESSETH, that the Grantor, for and in consideration of hlie�sum of (10.00) and other valuable considerations the receipt whereof is hereby ackaiowledged has granted, bargained, and sold unto the Grantee, and'Grantee�,,�,,syccessors, and assigns forever, all that certain parcel of land -Cqut4,y of Pinellas and State of Florida to wit: , Lots 16 and 17, and vacated 30.0 feet street west:,o 12?t<17, GLEN ELLYN ESTATES, according to the plat thereof as reccrd(;d irr Plat',Book 34, page 32 of the public records of Pinellas County, Flori$#. `�`> This property is not and never has been t44e liomestead;of Donald M. Kinkle who resides at 1127 Essex Dr, W Columbia, TAX POLIO NUMBER 242915310500000160 and Grantor does hereby fully warr4n•£ tit�e to.'said land and will defend the same against the lawful claims of`,ala`petsons whomsoever, except taxes for the year 2001 and subsequent year'sy/and restrictions, limitations, covenants, and easements of record, if any. /VGran�or,and Grantee" are used herein for singular or plural, the singu'.ar shall include plural, and any gender shall include all genders, as coritzextt, requires . ) , Signed, Sealed, and Del,iyfered'l.n `� p esence: (Wit.) � A, �; `. ' � (SEAL) Print: d M. ink (Wit. - _ (SEAT,) Print. ' State of County of The foregoing inAtument was acknowledged before me on July 44, 2001, by Donald M. klhkle„',a married person, who is personally known to me or has produced a dr�Yers license as identification and has taken an oath. WITNESS my signature and official seal in the county and state last aforesaid. My commission expires ary Public) 0 (Mfi xNotry Seal) i J J ” (CONTINUED ON FOLLOWING PAGE) ,,*K • =V .T o N �• Z.i o IV O r T 3o wZ vo CD o n NM CDW o D v X N i I w 0 W (CONTINUED}' Signed, Sealed, and Delivergd {Wit Print:Barbara J. Byls (Wit. - Print: .Taaaira M HaiAar PINELLAS COUNTY FLA OFF.REC.Sk "SOS PG 87 in o r presence: (SEAL) Kat in le £ k a Kathy KinkZe Garcia State of Florida, County of Pinellas: , I, (SEAL) The foregoing instrument was acknowledged before me on July ` 2001, by Kathy Kinkle f/k/a Kathy Kinkle Garcia, a single person, who is personally known to me or has produced'a`drivers license as identification and has taken an oath. /> WITNESS my signature and official Beal in the county- anti state last aforesaid. " My commijssion` e4iFes (Notary Public) dNw,, B-rbhrx J. Byhki 4r,tpmi»�n� . CC 811158 t g�PSw�,Apr.6 2003 W _ 'Bonded Thru _ ` ` atlnutk ponding co'. 1— LL 2100 BURNICE DR 0ANX2016-03012: } C earwater - .. Belcher Area Multiple Properties Zoning: Low Medium .Dens ty Re Atlas #: 308B 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. ALL PAGES WITHIN MUST BE SIGNED BY ALL PROPERTY OWNERS LISTED ON THE DEED. 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 FEE/ASSESSMENT FEE: TBD Information on Impact Fees or Assessment Fees is available from the City of Clearwater Engineering Department (562-4747). To Be Completed By City of Clearwater.- TYPE learwater:TYPE OF ANNEXATION: CONTIGUOUS X NONCONTIGUOUS (TYPE A ENCLAVE) To Be Completed By Property Owner: PROPERTY OWNER (PER DEED): Shirley Avis Allen MAILING ADDRESS: 2188 Bell Cheer Drive, Clearwater, FL 33764-4846 PHONENUMBER (�ai�-S(2a-1�OI EMAIL: mLA f1rY1o► 1 I yl'1 N1aw1 C�'�'� AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: PARCEL NUMBER(S): LEGAL DESCRIPTION CURRENT CITY SERVICES. REQUESTED CITY SERVICES: (select all that apply) i v- i✓Y1u i1 od t. qma,l .Corn 2188 Bell Cheer Drive, Clearwater, FL 33764-4846 24-29-15-06408-000-0020 Bell -Cheer Sub Lot 2 SANITARY SEWER SOLID WASTE WATER X SANITARY SEWER X SOLID WASTE Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562.4865 Page 1 of 7 Revised 04115 0 ,(Clearwater 0 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 SITE AREA: 0.236 PRESENT (COUNTY): REQUESTED (CITY): ZONING DISTRICT Residential Low (RL) Residential Low (RL) PRESENT (COUNTY): R-3, Single Family Residential REQUESTED (CITY): Low Medium Density Residential (LMDR) SIZE OF DEVELOPMENT: Existing: 1 Proposed (e.g., number of units, hotel rooms or non- residential square footage) acres USE OF PROPERTY: Existing (currently on site): Single Family Home Proposed (new use, if any; plus existing if to remain): Single Family Home If residential use, is unit(s) rental? WRE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? IF YES, PLEASE LIST/EXPLAIN: STATE OF FLORIDA, COUNTY OF PINELLAS YES ❑ NO 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 2-60h day of 1.r� '21-D. t(p . by S�.fYI%�.A �QG1; �CU1p� mn who is personally known/has produced 120r1da N Vg's b (,Llil';-P—as identification. Signature of property own(r or representative BROOKE L. MIM,,, NOTARY PUBLIC Notary public, LOR Dj *.- Comm# FF05= My commission expires: 10 2 JzDL-7 Expires 11012120-7 Signa re of property owner or representative Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-5624567; Fax: 727-5624865 Page 2 of 7 Revised 04/15 LL °� earwater �. U Planning &Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Shirley Avis Allen MAILING ADDRESS: 2188 Bell Cheer Drive, Clearwater, FL 33764-4846 PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: AY\f_ 4� ff)ArukvJ MAILING ADDRESS: 1l ©a9 100tA 1-1i2200 19A. 337)3 PHONE NUMBER: c2xz) S&C)- I-26 j EMAIL: ^Mu r1 Vne i.l,m Q a M44I1.cloyn THER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY - NAME: f411��`c. M! uW � - 5wi)i ;qn-n 1�4n-2— INTEREST IS: SPECIFIC INTEREST HELD: OES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY?, YES _ NO CONTRACT IS: PARTIES INVOLVED - NAME: PHONE NUMBER: NAME: PHONE NUMBER: RE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? YES �� NO PARTIES INVOLVED - NAME: PHONE NUMBER: NAME: PHONE NUMBER: RE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? YES NO PARTIES INVOLVED- NAME: �ATjUY1S�Al2 ��, yq ¢ PHONE NUMBER: A4 �50 alii3ol NAME: 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 2C(4" day of Ff,�VI�IAvIG 70 1 CP by gg(Yi:Q.I/ ) (wi Naluffe ty0fido, is personally known/has produced vu -S L:(Labo �i as identification. Signature of pr Apert owner or representative BROOKE L. MIMS 9- J&% NOTARY PUBLIC Notary public, i Comm# FF059381 i My commission expires: / � l Tres Signatur of property owner or representative Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-5624865 Page 5 of 7 Revised 04/15 Clearwater Planning & Development Department Petition for Annexation Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed —PRINT full names: Shirley Avis Allen Shl2��u nYt -F?-A,nZ 'K�Sntj �(lnutt,�l 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 2188 Bell Cheer Drive 3. That this property constitutes the property for which a request for (describe request): 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 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 (1/we) the undersigned authority, hereby certify that t1 f"L'4� =uedc ect Prop rt ov r Properhy 0 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 2_ � r , DAY OF r�r %�Y r f,, I 2Dj�1� PERSONALLY APPEARED ;Y d r LtSI �" ` A lX_ I', Nary ff e ` f SY � h i " WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. BROOKE L. MIMS NOTARY PUBLIC STATE OF FLORIDA . Comm# FF059381 Expires 10/2/2017 Notary Seal/Stamp Notary Public Signature My Commission Expires: /D12, Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 6 of 7 Revised 04/15 °ClRarwater Planning & Development Department Petition for Annexation Sunnlemental Statement PROPERTY OWNER (PER DEED): Shirley Avis Allen MAILING ADDRESS: 2188 Bell Cheer Drive, Clearwater, FL 33764-4846 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. Select One Option Below Which Applies to This Petition for Annexation: ❑ Annexation of Contiguous Parcel(s): 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. ' X Annexation of Noncontiguous Parcel(s): I/we understand that this annexation is voluntary, and that I/we may withdraw this Petition for Annexation prior to final action on this Petition by the City of Clearwater. I/we further agree and acknowledge, however, that receipt of all sewer, solid waste or other city service is contingent upon completion of the Petition for Annexation process, and that any withdrawal of this Petition prior to final action by the City, may result in a discontinuance and termination of all City -provided services. 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 2A rh day of Signature of property o ner (individual or authorized representative of corporation, partnership or other entity) n 11 _ of co -property owner 'Llf FSI �• ( QM; NU&C M lois personally known/ has produced Ck-mc'-< as identification. BROOKE L. MIMS NOTARY PUBLIC P;A &'fi nA . .., a STATE OF FLORIDA Notary, public, My commission expires: / Expires 10/2/2017 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-5624865 Page 7 of 7 Revised 04/15 I#: 2005276990 BK: 14457 PG: 676, ' '15/2005 at 03:30 PM, RECORDING 1 PAGr $10.00 D DOC STAMP COLLECTION $0.7, MN BURKE, CLERK OF COURT PINELLAS COUNTY, FL BY DEPUTY CLERK: CLKDM82- PREPARED BY AND RETURN TO Luis Garcia -Rivera, Esq. 2706 Alternate U.S. 19 N. Suite 223 Palm Harbor, FL 34683 (727)772-8818 ' life estate sub - THIS LIFE ESTATE DEED, - . ` ','> Made this 1G` day of July, A.D. 2005 By SHIRLEY AVIS ALLEN, a Single Woman, whose post office address is 2188 Bel -Cheer Drive, Clearwater, FL, 33764, Hereinafter called the grantor, to SHIRLEY AVIS ALLEN, a Single Woman, - - whose post office address is 2188 Bel -Cheer Drive, Clearwater, FL, 33764 a Life Estate without any liability for waste, with full power and authority in her to sell, convey, mortgage, lease and otherwise dispose of the property described below in Fee Simple, with or without consideration, without joinder by the remainderperson, and to retain absolutely any and all proceeds derived therefrom. Upon the death of the Life Tenant, the remainder, if any, to NANETTE MANUEL and SHIRLEY ANN FRANZ. WITNESSETH: Grantor, in consideration of the sum of Ten Dollars ($10.00) and other good and valuable considerations, receipt of which is hereby acknowledged, does hereby grant, bargain, sell, convey and confirm unto the grantee, all that certain land situated in Pinellas County, Florida, to wit: Lot 2, BEL -CHEER SUBDIVISION as recorded in Plat Book 30, page 6,0, Public ' Records of Pinellas County, Florida. Parcel ID # : 24 / 29 / 15 / 06408 / 000 / 0020 This is a DEED OF CONVENIENCE given for nominal considyration Subjycmej�rictions, reservations, liens, and mortgages of record and taxes levied for the currdgt%year. To have and to Hold, and same in fee simple forever. And the grantor hereby covenants with said grantee that the grantor is lawfully`seized of said land in fee simple; that the grantor has good right and lawful authorWjo sell and yronvey said land; that the grantor hereby fully warrants the title to said land and will defeh4Rhe same�pgainst the lawful claims of all persons whomsoever; and that said land is free ofall enolphbra&ca c ccdpt taxes accruing subsequent to December 31, 2004. ` Whenever used herein the term "Grantors" alri%"Qrda tees" include all the parties to this instrument and the heirs, legal representatives and assigns` of'4ndividuals, and the successors and assigns of corporations. IN WITNESS WHEREOF, the e signed and sealed this Deed the date above written. Signed, sealed and delivered jn t}1e.presq"r,(Jf•, WITNESS ; ; SHIRLEY��-77AVIS ALLEN Lin � ro � 00i-04 •1 ( Print e) _ - CD 0 N CD CCD O WITNESS, b,r ,, mita C' =' /� (pit name) , , rD W Z 2 _ STATE OfiFLOif(I)A o �0 COUNT"QI PNELLAS 1� 1V rn The foregoing instrument was aalmowledged before me this 1�_' �day of July, 2005 by SHIRLEY AVIS ALLEN (DD y Q who is personally known to me or who has produced as iden ' on. D T /V MY� W y EXPIRES: ADA s. W WXyPj °u4V*T "i ARY PUB 1 TATE OF FLORI A w O My n xpires: Co E ArP,: BMATU AYU BEAMITUL • BAY'M BEACH Case # ANX2016-30012 SIGN POSTING ACKNOWLEDGEMENT hereby acknowledge that the signs required for this case being considered by the City of Clearwater for annexation were posted a minimum of 10 days before the City Council First Hearing. The signs were posted on the subject property in a location where they are capable of being read from the most significant adjacent street. Planning & Development Department Staff: \�-,Vc— Print arae - Sign Name City Council Public Hearing Dates: • May 19, 2016 (1St reading) • June 1, 2016 (2nd reading) Date Posted May 6, 2016 Photo of sign uploaded into Accela ,e;l�/ l� Date Deadline to Post May 9, 2016 .i nnexation Map Reques Planner Name: Kyle Brotherton Case Number: ANX2016-03012 Date Request Submitted: 3/2/16 Date Requested for: 2/16/16 Maps Needed ❑ Location Map ® Aerial Photograph ® Proposed Annexation ® Future Land Use Map ® Zoning Map ® Existing Surrounding Uses Map ® 2" x 2" PDF Map (for Newspaper) Required Documents ❑ Legal Descriptio warranty deed survey) - to be hand delivered ® Map with Proposed i ighted ® EDR - no hard copies submitted- all submission material is accessible through Accela Location & Right-of-Way Language (for Ordinance Title) Location: Located generally south of Druid Road, east of South Hercules Avenue, north of Lakeview Avenue, and west of South Belcher Road. Right-of-Way: jENG1NEERING`INSERT ROW DES IPT�I N ORaN% FIERE kOPROVIDED LEGAL DESCRIPTION VERIFIED BY: Tho as Mahony, SM, deogohic Technology Manager MAP NAME Owner(s): Multiple Owners Case: ANX2016-03012 Site: 2100 Burnice Drive Property Size(Acres): 0.742 2188 Bell Cheer Drive ROW (Acres): Land Use Zoning PIN: 24-29-15-31050-000-0160 24-29-15-06408-000-0020 From : RL R-3 To: RL LMDR Atlas Page: 308B COLLEGE DR v BURNICE DRJW y BELL CHEER DR , 1 7j d 3t' 1 k vets. d `uT f"t :N� t v N - �• t� COLLEGE DR Z V BURNICE DR W BELL CHEER DR ' Ah Ak DRUID RD o _ o 2 2 CAMPUS DR CROYDON DR � Rev. 3/9/2016 cz cz ACADEMY DR KENMOORE DR Ix W .. zj ZLU j MAGNOLIA DR Z Uj Q p O � L V 2 I UNIVERS Vry COLLEGE DR RIPON DR PROJECT SITE S UNIVE ITY DR W 2 JEFFORDS ST J D ° BURNICE DR REBECCA DRLU ' C ' SANDRA DR \ p ? //O^^ ,Y •' BELL CHE R R CZ 44 R . .. �. �Y •' '•'..• __. _ LEES CT } • . • • • • : -' ' ; • •DORADO PL ' •; LOCATION MAP Owner(s): Multiple Owners Case: 7 ANX2016-03012 0.742A Site: 2100 Burnice Drive SizeProperty Size(Acres): 2188 Bell Cheer Drive ROW (Acres): Land Use Zoning PIN: 24-29-15-31050-000-0160 24-29-15-06408-000-0020 From : RL R-3 To: RL LMDR Atlas Page: 308B >♦ Ah 1001 1000 C UNIVERSITY CT g 10:2COLLEGE DR 2 hobss n^6h 1005 1La ti M 1 _006 y o , 88 c a tl 70 3 W 130 N 131 N 132 N N 133 21 It `j6 87 N 86 N 85 N 84 N 127 Zroh ��110 Rev. 3/9/2016 104 1100 138 N 137N 138 N 135 N 34 co O tp N 00 4 4 105 106 107dp 10�,p 109a Of 110 128 N N N N N N 5 8 S UNIVERSITY DR 125 p r N M IV tip 00 (h O Ich m 6 124 N 123 N 122 N 121 N 120 N 119 N 118 117 n V_ � V_ V so 1107 N N 116 N 115N 114 N 113N 112 N »�N ` 1111 :. + ;'• s 8 • •1¢•, •91� '•'•d0' tii, 15� 140 >�V .1?C• ' . ap N� C3 81p 5 4 3 2 1 O7 '�:. •. so •• V. � `"' !i105 LO to o r` :° a) 1200 N N N N N' ty • I N N N N N N BURNICE DR 60 C p •• '. 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' 4 2115 ;7C. ;. 00.�,....: N _ •' ... �..'. . , .. r„t�• IN PROPOSED ANNEXATION Owner(s): Multiple Owners Case: ANX2016-03012 Property 0.742 Site: 2100 Burnice Drive Size(Acres): • 2188 Bell Cheer Drive ROW (Acres): Land Use Zoning 24-29-15-31050-000-0160 PIN: 24-29-15-06408-000-0020 From : RL R-3 To: RL LMDR Atlas Page: 3088 Ah Ah 1001 1000 s UNIVERSITY CT 2 102 A fis 1 128 ch 1 ti 1006f4U 10 88 N 00 a) ° a 3 1 0 N N N N W 3 131 132 133 Z CjF1 87 N 86 N 85 N 84 N Z �A 127 � Rev. 3/9/2016 \\ q q Z co to N 1100 ' 138 137 136 � 135 � 34 1P104 105 106 107000 10®p 109p 110 N N N N N 126 N N N N N Q s LL= S UNIVERSITY DR 6 % 125 C N M V' <0C Op O^p b df M so 124 r r N 123 N 122 tV 121 120 119 118 1107 N N N N 117 N 116 N 115 N 114 N 113 N 112 N 111 N 1111 7 : ` •` ` •: 9 616 ';1'1`7•' ••'9'1�, ••`•40. 8 17 151N 140 1� 00 N� d 6 5 4 3 2 1 g.• ,.: 0 a qC �i105 N N N ; ..N ..' N' H •;; oof Qq0 N N N N N NL BURNICE DR m O N rl 1• ' 4l' O N M M d �O• qC 1� 0) t� N �` e+ �. 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OLJ/ •:�� o 4 ; . • .. .: 6I� ZONING MAP Owner(s): Multiple Owners Case: ANX2016-03012 Property 0.742 Site: 2100 Burnice Drive Size(Acres): 2188 Bell Cheer Drive ROW (Acres): Land Use Zoning PIN: 24-29-15-31050-000-0160 24-29-15-06408-000-0020 From : RL R-3 To: RL LMDR Atlas Page: 308B 1 Ah Ah 1001 1000 C g \ s UNIVERSITY CT � v COLLEGE DR �� as ti�6� 1o1Q� z 4 ?, 1005 '1006 v� .`^. 1 ago c a 106 130 N 131 N 132 N N 133 Z1 V- V- V 87 N 86 N 85 N 84 N 127 Rev. 3/9/2016 ,00 O 1100 A ' 138 137 M 104 V.-136 N 34 105 106 107p�p 100p 109p 0, 110 4 4 It- V-135 V- 3 N N N N N N N N N N 126 5 9 S UNIVERSITY DR 8 125 O7 Cl r M NM !� n ^ df Cf COf 124 50 1107 N 123N 122N 121N 120N 119N 118N 117N 116N 115N 114 113 112N ,11N 11 •'; ;': 1111 .:• •,�,da. • 9 8 7 •;ii, •,¢• 19, •?`1O••• ••'� side l[l l '• 15N 140 O N"_"' dIte 3 2 1 O ' �:. .. N M. ' ; �. N op a O 50 `, °�° 1200 N N : ;� .. �, .. VQ — �� c c V. V. °: N N" N N N N N N BURNICE DR oh 60 IV N 00 M t- e. 11. V. V. V. a., %. V. 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