ANX2016-05017`'Clearwater
1608 LE - - - - - -ARN ST
ANX2016-05017
1608 Lavern Street - Barrett
Zoning: Low Medium Density Atlas #: 270B
ALL APPLICATIONS ARE TO BE FILLED OUT COMPLETELY AND CORRECTLY, AND SUBMITTED 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.
ONE (1) COMPLETE SET (1 ORIGINAL APPLICATION AND SUPPLEMENTAL MATERIALS) AS REQUIRED WITHIN IS TO BE
SUBMITTED FOR REVIEW BY THE DEVELOPMENT REVIEW COMMITTEE.
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: CONTIGUOUS X NONCONTIGUOUS (TYPE A ENCLAVE)
To Be Completed By Property Owner.
PROPERTY OWNER (PER DEED): Daniel L. Barrett
MAILING ADDRESS: 1608 Lavern St, Clearwater, FL 33755-3718
PHONE NUMBER: 727-642-5430
EMAIL:
AGENT OR REPRESENTATIVE:
MAILING ADDRESS:
PHONE NUMBER:%L- "j L _ -r,
EMAIL:
ADDRESS OF SUBJECT 1608 Lavern St, Clearwater, FL 33755-3718
PROPERTY:
PARCEL NUMBER(S): 11-29-15-39060-003-0070
LEGAL DESCRIPTION: Highland Pines Sub Blk 3, W 50 Ft of Lot 7 & E 40 Ft of Lot 8
SOLID WASTE/
CURRENT CITY SERVICES: SANITARY SEWER RECYCLING X WATER
SOLID WASTE/
REQUESTED CITY SERVICES. SANITARY SEWER X RECYCLING WATER
(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 02/16
° 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: 0.22
SIZE OF DEVELOPMENT:
Existing: 1
Proposed: 1
(e.g., number of units, hotel rooms or
non- residential square footage)
Single Family Residential (R-3)
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?
ARE 7#1ERE ANY AC►IVE/iiPEN PER TS R THE`F'ROPERTY WITHIN PINELLLN- COUNTY?
IF YES, PLEASE LIST/EXPLAIN:
STATE OF FLORIDA, COUNTY OF PINELLAS
Single Family Home
Single Family Home
No
YES ❑ NO
(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 Z(P day of
�pri l 20� by
13a rr>✓t P�f,o is p r o a ly'``
known/has
produced FL PY IVUS W�f &e as identification.
ure of property owner or representative
am -4b -MICHELLE THORNTON
NOTARY PUBLIC
STATE OF FLORIDA Notary public,
e Comm# FF006875 My commission expires: X4-10 a.0 !"1
&ekv Mrdowner or egres n ive
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865
Page 2 of 7 Revised 02/16
ater
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:
❑ 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.
❑ 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/or engineering plans are required. 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).
❑ 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).
❑ If applicant is designating an agent/representative to work with City, applicant must provide notarized Affidavit to
Authorize Agent/Representative (form attached).
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 extgis.myclearwater.com/Zoning.
❑ 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: 727-562-4865
Page 3 of 7 Revised 02/16
LL �
°_ �� earwater
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 11 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.
i
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865
Page 4 of 7 Revised 02/16
o `
..w earwater
0
Planning & Development Department
Petition for Annexation
Disclosure Statement
PROPERTY OWNER (PER DEED): Daniel L. Barrett
MAILING ADDRESS: 1608 Lavern St, Clearwater, FL 33755-3718
PHONE NUMBER: 727-642-5430
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 CONTRACTTEXIST EOR SALE OF THE SUBJECT PROPERTY?
YES NO
CONTRACT IS:
PARTIES INVOLVED - NAME:
PHONE NUMBER:
NAME:
PHONE NUMBER:
E 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 NO
_. _- _._ , . .m.. . ._ -s. __.._. -,-_
PARTIES INVOLVED-NAME:�A�Y
PHONE NUMBER:
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 stp day of
)- pr) f 20 I (a . by
Nkn iLl L n a�rrie.-ti- Pew. p sfty kno n/has
I ,� ��'�j�� produced Drt V�'� �-(- c�i'18>°- as identification.
of property owner or representative
LAp MICHELLE THORNTON 4 t (, e
NOTARY PUBLIC `�`� - �"-
STATE OF FLORIDA Notary public,m
M , Com# FF006875' My commission expires: Qq- (U -ZD (1
ure
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865
Page 5 of 7 Revised 02116
s'Clearwater
Planning & Development Department
Petition for Annexation
Affidavit to Authorize Agent/Representative
1. Provide names of all property owners on deed —PRINT full names:
Daniel L. Barrett
2. That (I am/we are) the owner(s) and record title holder(s) of the following described property:
1608 Lavern Street
3. That this property constitutes the property for which a request for (describe request):
Annexation of single family residence
4. That the undersigned (has/have) appointed and (does/do) ap
as (his/their) agent(s) to execute any petitions or other documents n6ce"tsary 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. 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 2� DAY OFF .A 19r I Wi tP PERSONALLY APPEARED
DGLiR1Pi� �i° 80-rrt7tt + 19kut ftndret,)S WHO HAVING BEEN FIRST DULY SWORN
DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED.
®MICHELLE THORNTON
NOTARY PUBLIC
STATE OF FLORIDA
Comm# FF006875 Notary Public Signature
r, Expires 4/10/2017
Notary Seal/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 02/16
°Clearwater
PROPERTY OWNER (PER DEED):
Daniel L. Barrett
Planning & Development Department
Petition for Annexation
SUDDlemental Statement
MAILING ADDRESS: 1608 Lavern St, Clearwater, FL 33755-3718
CITY OF CLEARWATER CASE
NUMBER:
1/we, a m r L4 j zk re eoc�-
[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 Zko day of
A nriff ISO I (,P �by
Y�
,1'101 (�•Vr`I w' ho is -personally known/has
produced (. DvLVf-rS JX�c e_ as identification.
5-19nature of property oWtrr6—r(in ividual or authorized
representative of corporation, partnership or other
entity) MICHELLE THORNTON �L
NOTARY PUBLIC Notary public,
STATE OF FLORIDA
Signature of
Expires 4/10/2017
My commission expires: 04-10—
Planning
4-10—
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865
Page 7 of 7 Revised 02/16
Annexation Map Request
Planner Name: Kyle Brotherton
Case Number: ANX2016-05017
Date Request Submitted: 5/6/16
Date Requested for: 5/20/16
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
0 Legal Descriptio (warranty d ed or survey) - to be hand delivered
® Map with Propose ghlighted
® EDR - no hard copies submitted - all submission material is accessible through Accela
Location & Right-of-Way Language (for Ordinance Title)
Location: Located on the north side of Levern Street approximately 95 feet west of Ridge
Avenue.
Right-of-Way: [ENGINEERING INSERT ROW DESCRIPTION OR N/A-HERE]
PROVIDED LEGAL DESCRIPTION VERIFIED BY:
Th mas Mahon;, PS , G graphic T chnology Manager
MAP NAME
Owner(s): Daniel L. Barrett Case: ANX2016-05017
Property 0.215
Site: 1608 Levern Street Size(Acres):
ROW (Acres):
Land Use Zoning
PIN: 11-29-15-39060-003-0070
From : RL R-3
To: RL LMDR Atlas Page: 270B