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ANX2016-05018:Clearwater X2138 BELL CHEER DR ANX2016-05018 Bell Cheer Drive - Multiple properties Zoning: Low Medium Density Atlas #: 3088 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: x CONTIGUOUS NONCONTIGUOUS (TYPE A ENCLAVE) To Be Completed By Property Owner. PROPERTY OWNER (PER DEED): Ivan Radimushkin & Natalya Petruhina MAILING ADDRESS: 2112 Bell Cheer Drive, Clearwater, FL 33764 PHONE NUMBER: 14211 EMAIL: pena.plush@gmail.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: PARCEL NUMBER(S): 2112 Bell Cheer Drive 24-29-15-06444-000-0030 LEGAL DESCRIPTION: Lot 3, Bell -Cheer Subdivision 2nd Addition CURRENT CITY SERVICES: REQUESTED CITY SERVICES: x (select all that apply) SANITARY SEWER SANITARY SEWER SOLID WASTE x SOLID WASTE WATER WATER Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 1 of 7 Revised 03/16 I0 �IeArwater 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: 0.24 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) rental?. Single Family Residential Single Family Residential ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? YES ❑ NO 91 IF YES, PLEASE LIST/EXPLAIN: 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 1'�� day of 0,_0 Yl by Jot, iod", ., li ) musy&04- VL u who,is personally known/has produced i; Z r A c,,' ir'1 VZi'S ��CQ,yias identification. Signature'of property owner or representative / - C___N•6tary public, < y-orrrmission. �l t.V\t- 20 Signature of pro o� r representative ��` G�, ^ 8°'x= ``' " rFFISEN �. . of Florida --..... m 3 �qe . LAUREN PETERSEN n : >• -a Julie 13, 2017 �` � Notary Public, Stats of Florida Planning &Development Department, 100 S. Myrtle Avenue, Clearwater, FL ,Tel: 727 56nF 27391 Page 2 of 7 9 _.�_,w_ _ . Y isi� age 13, 2017 ''Clearwater 0 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 engineering plans shall be submitted. 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://Ris.pinellascounty.org/public gis/. ❑ ZONING DISTRICT (CITY) can be found by contacting the Planning and Development Department or viewing the City's online Zoning Viewer extgis.mvclearwater.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.pineIlascounty.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 03/16 °!Clearwater 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 03/16 o� � 1'1 _ Arwater 0 - Planning & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Ivan Rodimushkin & Natalya Petruhina MAILING ADDRESS: 2112 Bell Cheer Drive, Clearwater, FL 33764 .PHONE NUMBER: W/4—N45 EMAIL: pena.plush@gmail.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: (J/� INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? YES V NO CONTRACT IS: PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? YES V NO PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? YES _� NO PARTIES INVOLVED—NAME: 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 applic ion. Sworn to and subscribed before me this L�l day of t? -U— 2Z110 . by Aq i A ��r?JJV114 who is personally known/has produced b 21 4 ,4� j r>p as identification. Signaturd.8T property owner or representative Signature or represe Planning & Development Page 5 of 7 s t Notary pul My commi J. M. p ex fires: Tel: 727-562-4567; Fax: 727-562-4865 Revised 03/16 STATE OF FLORIDA COUNTY OF PINELLAS Sworn to (or affirmed) and subscribed before me this 13 day ofAeInL by lillflv Type of Identification Produced yG VLADIMIR BORISSOV O VLADIMIR BORISSOV Notary Public of State of FloridaMY COMMISSION #FF038509 USA EXPIRES November 15. 2017 I Florldnhlotary$orvice.com STATE OF FLORIDA COUNTY OF PINELLAS Sworn to (or affirmed) and subscribed before me this 13 day ofAeInL by lillflv Type of Identification Produced yG o / �� Planning & Devel ment Department eArwaterr Petition Annexation Affidavit to Authorize Agent Representative 1. Provide names of all property owners on deed —PRINT full names: Ivan Rodimushkin Natalya Petruhina 2. That (I am/we are) the owner(s) and record title holder(s) of the followi g described property: 2112 Bell Cheer Drive, Clearwater, FL 33764 3. That this property constitutes the property for which a request fo (describe request): Annexation in order to receive solid waste and sanitary sewer rvice from the City. 4. That the undersigned (has/have) appointed and (does/d appoint: as (his/their) agent(s) to execute any petitions oro er documents necessary to affect such petition; 5. That this affidavit has been executed to induce a City of Clearwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary y City representatives in order to process this application and the owner authorizes City representatives to vi t and photograph the property described in this application; 7. That (I/we), the undersigned authority, reby certify that the foregoing is true and correct. Ivan Rodimushkin Property Owner Property Owner Natalya Petruhina Property Ow er 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 _ _ /DAY OF , , PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN DEPOSED ADM SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Public Signature Notary Sq"al/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 03/16 04 � Cearwater U PROPERTY OWNER (PER DEED): Ivan Rodimushkin & Nata lya Petruhina Planning & Development Department Petition for Annexation SUDDlemental Statement MAILING ADDRESS: 2112 Bell Cheer Drive, Clearwater, FL 33764 CITY OF CLEARWATER CASE NUMBER: I/we, _Ivan Rodimushkin and Natalya Petruhina [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. ❑ 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 (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. J.3 -r`, day of by -'r 1vc�h iLo(� sMus1�l,�� d }ni 04iho is personally known/has A/ produced `{Y1�r�G.S L t C�V`�. as identification. Signat&df property owner (individual or authorized representative of torpor. pert,-• rtnership or other entity) Nota lic,. .l,.. ..____- _[JA.'y 7 r LAtlR ipr @�,�ion xpires: � AVIC (J � Signature of co pr rty own r� �' Notary Public, Staleot Florida Commission # FF 27391 . expires June 13 201 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 7 of 7 Revised 03/16 :(Clearwater0 Iw--- _ r 2138 BELL CHEER DR ANX2016-05018 Bell Cheer Drive - Multiple properties Zoning: Low Medium Density Atlas #: 308B 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: IMPACT FEE/ASSESSMENT FEE: To Be Completed By City of Clearwater.- TYPE learwater:TYPE OF ANNEXATION: x . $0 TBD Information on Impact Fees or Assessment Fees is available from the City of Clearwater Engineering Department (562-4747). CONTIGUOUS NONCONTIGUOUS (TYPE A ENCLAVE) To Be Completed By Property Owner: PROPERTY OWNER (PER DEED): Grover M. Hartford MAILING ADDRESS: 2138 Bell Cheer Drive, Clearwater, FL, 33764 .PHONE NUMBER:J�j-2 31 EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: 2138 Bell Cheer Drive, Clearwater, FL 33764 PARCEL NUMBER(S): 24-29-15-06408-000-0090 LEGAL DESCRIPTION: Lot 9, Bell -Cheer Sub CURRENT CITY SERVICES: SANITARY SEWER SOLID WASTE WATER REQUESTED CITY SERVICES: x SANITARY SEWER x SOLID WASTE 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 03/16 LL a� 0 F arwater 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- residential 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) rental? ,ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? IF YES, PLEASE LIST/EXPLAIN: STATE OF FLORIDA, COUNTY OF PINELLAS Single Family Single Family Nim YES ❑ NO X 1 (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 j3O I l -p by who is personally known/has produced NEL D L�tk(D3\o�� I YAMR o as identification. Signature of property owner or Notary public, - My commission expires: 9a 5�-'.Vv 6 Signature of property owner or representative ,gt cm Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, T f:,727= A567• -562-4865 Page 2 of 7 k Revised 03/16 °;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. ❑ 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. 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 online Zoning Viewer 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 03/16 0 4 �1 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 03/16 Xl�arwater .�.:. U PROPERTY OWNER (PER DEED): Grover M. Hartford Planning & Development Department Petition for Annexation Disclosure Statement MAILING ADDRESS: 2138 Bell Cheer Drive, Clearwater, FL 33764 PHONE NUMBER: 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 SUBJECT 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 NO PARTIES INVOLVED—NAME: 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 ``J�- day of by b` ec ( e who is personally known/has o /� ,/,�� produced �L SbL -Roo A t �3.4")-OAfl t--) as identification. Signature of property owner oWpresentative Notary public, My commission expires: Signature of property owner or representative r S.4w,00 "'23.20, M`1 Planning &.Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel 27- 67; Fax: 727-562-4865 Page 5 of 7 Revised 03116 '\ Planning & Developme Department eaterarwPetition for nexation Affidavit to Authorize Agent/Re esentative 1. Provide names of all property owners on deed —PRINT full names: Grover M. Hartford 2. That (I am/we are) the owner(s) and record title holder(s) of the following descr' ed property: 2138 Bell Cheer Drive, Clearwater, FL 33764 3. That this property constitutes the property for which a request for (descr' a request): Annexation in order to receive solid waste and sanitary sewer service om the City. 4. That the undersigned (has/have) appointed and (does/do) appo' t: as (his/their) agent(s) to execute any petitions or other do uments necessary to affect such petition; 5. That this affidavit has been executed to induce the Cit of Clearwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by Ci representatives in order to process this application and the owner authorizes City representatives to visit an photograph the property described in this application; 7. That (1/we), the undersigned authority, here certify that the foregoing is true and correct. Grover M. Hartford Property Owner Property Owner Property Owne Property Owner STATE OF FLORIDA, COUNTY OF PINELLAS BEFORE ME THE UND SIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON THIS DAY OF PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN DEPOSED #4D SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Nota r,j� Sea I/Stam p 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 03/16 'Clearwater PROPERTY OWNER (PER DEED): Grover M. Hartford Planning & Development Department Petition for Annexation Supplemental Statement MAILING ADDRESS: 2138 Bell Cheer Drive, Clearwater, FL 33764 CITY OF CLEARWATER CASE NUMBER: I/we, _Grover M. Hartford [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: 0 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 (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 QE's t . a0t _p . by Ac. 'a \�` �s who is personally known/has produced as identification. Signature of property owner Adividual or authorized I representative of corporation, partnership or other entity) AO Notary public,.43.201 My commission Signature of co -property owner Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 7 of 7 Revised 03/16 C2138 BELL CHEER DR �+ ANX2016-05018 orclearwater 'Bell i Bell Cheer Drive -Multiple properties #: 308B ' -_ow Medium Density -�-- ' Zoning. L J U` AND SUBMITTED TO THE PLANNING & ALL APPLICATIONS ARE TO BE FILLED OUT COMPLETELY AND CORRECTLY, DEVELOPMENT DEPARTMENT BY NOON ON THE SCHEDULED DEADLINE DATE. ALL PAGES WITHIN MUST BE SIGNED BY ALL PROPERTY OWNERS LISTED ON THE DEED. ION AND MATERIALS) AS REQUIRED WITHIN IS TO BE ONE (1) COMPLETE SET (1 ORIGINAL APPLICA SUBMITTED FOR REVIEW BY THE DEVELOPMENTREVIEW 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 Fe ssment Fees is available IMPACT FEE/ASSESSMENT FEE: TBD Information on Impact es orAsse the City of Clearwater Engineering Department (562-4747). from To Be Completed By City of Clearwater: NONCONTIGUOUS (TYPE A ENCLAVE) TYPE OF ANNEXATION: X CONTIGUOUS To Be Completed By Property Owner: PROPERTY OWNER (PER DEED): Rory Thompson and Lillian Thompson MAILING ADDRESS: FL �q Sb �lGirh2f Q PHONE NUMBER: 727-656-5346 '�� ' " EMAIL: Lapdipfla aol coin Clea4,wdj-`� 337600 AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: 2196, 2198 Bell Cheer Drive, Clearwater, FL 33764-4846 PARCEL NUMBER(S): 24-29-15-06408-000-0010 LEGAL DESCRIPTION: Bell -Cheer Sub E 112 Ft of Lot 1 SOLID WASTE/ CURRENT CITY SERVICES: SANITARY SEWER RECYCLING WATER SOLID WASTE/ REQUESTED CITY SERVICES: X SANITARY SEWER X RECYCLING WATER "Y (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 01r 1e\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 THE FOLLOWING APPLICATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY): Residential Low (RL) REQUESTED (CITY): Residential Low (RL) ZONING DISTRICT PRESENT (COUNTY): Single Family Residential (R-3) REQUESTED (CITY): Low Medium Density Residential (LMDR) SITE AREA: 0.35 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): dlf residential use, is unit(s), 'rental? - --- Single —---- Family Residence Single Family Residence `R�RE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY. YES ❑ IF YES, PLEASE LIST/EXPLAIN: STATE OF FLORIDA, COUNTY OF PINELLAS 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–d& i' Sworn to and subscribed before me this " day of by oaAj 1 hong i�5b h `a )j') 1 who is personally kno ha< 7/ ,c..�---7 .Z - produced -L bL s as identification. of property owner or representative Notary public, N My commission expires: re of property owner or TFIMA U. HOFBAUER Notary Public, State of ROM comm. expires July 14, 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 _0�a rwaterPlanning & Develo ment De artmentr�� 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.ore. ❑ 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 ore/public eis/. 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:/ c eis/. ❑ ZONING DISTRICT (CITY) can be found by contacting the Planning and Development Department or viewing the City's Zoning Atlas, available online at exteis.mvclearwater.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: 727-562-4665 Page 3of7 Revised 02/16 °Clearwater 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 02/16 0 Clearwater 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 Rory Thompson and Lillian Th 727-656-5346 iapdipfla@aol.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 SUBJECT PROPERTY? CONTRACT IS: PARTIES INVOLVED - NAME: NAME: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? PARTIES INVOLVED - NAME: NAME: YES PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? ✓ YES PARTIES INVOLVED- NAME: PHONE NUMBER. - NAME: PHONE NUMBER: v- NO k,� NO 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 4 -9L day of MO.Al 1 to by PoYu L.i < <<�' aM j2som , who is personally kno has produced h> L /s as identification. of property owner or representative Notary public, , '� /�f /'7 �+ A TREASSA M. HORBAUER Notary Public, State of Florida (� My commission expires: i� �1 of property owner or represerleative My comm. expires Jury 14, 2017 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 5 of 7 Revised 02/16 r -U. °�learwater Planning & Development Department Petition for Annexation Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed —PRINT full names: Rory Thompson Lillian Thompson 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 2196, 2198 Bell Cheer Drive 3. That this property constitutes the property for which a request for (describe request): Annexation of a duplex 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; l7 That e), the uncle igned authority, hereby certify that the foregoing is true and correct. `V P-r'o]perty OwWer Property Owner Property 6wner 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 -AL DAY OF —^ n1 AM -1016 , PERSONALLY APPEARED E14 LJ' / Il l�,s� 1 hp I SO✓iL. WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND SAYS TH HE SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. MAUER RM te of Fiodda FF 29232 July 14, 2017Nota Notary Mblic Signature My Commission Expires: :1//4111 Planning 1'i4l/1 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 6 of 7 Revised 02116 ,.P#ahhing & Development>Depar Ot, 10D 5. Myrtle Avenue; Clearwater, FL 33756, Tei 7-2t-542--456t; Fax. 727-562-4865. Page To 7 Revised.U2i15 o(("��' Planning & Development Department 'Varwater Petition for Annexation Supplemental Statement PROPERTY OWNER (PER DEED): L;rf ( h fAt_ J- rimy -U j MAILING ADDRESS: AM Xq $n -9-7760 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: �i 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. O Annexation of Noncontiguous Parcel (s): I/we understand that this annexation is voluntary, and that [/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 (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.l Sworn to nand subscribed before me this day of by / ppm W bII1 /kwmnsa t , who is personally known/has x(�" produced FL >c�L Is as identification. Signature of -property owner (individual or authorized representative of corporation, partnership or other entity) Notary public, Mr4l�ljl W_.y commission expires: EASSA M�BAHE at a f.co-property owner -, .`* Notary Public, State of Flori �mmisilon # FF 29232 M comm. expires July 14, S 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 71 .. A ,_..a I#: 2011232626 BK',17345 PG: 372, 09/02/2011 at 08:27 AM, RECORDING 2 PAGES $18.50 D D064STA P COLLECTION $349.30 KEN BURKE, CLERK OF COURT PINELLAS COUNTY, FL BY DEPUTY CLERK: CLKPR03 ME Prepared by and return to: Frances Jackson Sun Gulf Real Estate Services, LLC 31564 U.S. Hwy 19 N. Palm Harbor, FL 34684 727-526-3529 File Number: 11-580 Will Call No.: [Space Above This Line For Recording Warranty Deed This Warranty Deed made this 29th day of August, 2011 between Kara M. Rossewey, an unremarried widow and surviving spouse of Timothy J. Rossewey, deceased whose post office address is 14000 US Hwy 19 N, Clearwater, FL 33764, grantor, and Yelena Holcomb, a married woman whose post office address is 1529 South Jefferson Ave, Clearwater, FL 33756, grantee: (Whenever used herein the terms "grantor" and "grantee" include all the parties to this instrument and the heirs, legal representatives, and assigns of individuals, and the successors and assigns of corporations, trusts and trustees) Witnesseth, that said grantor, for and in consideration of the sum of TEN AND NO/100 DOLLARS ($10.00) and other good and valuable considerations to said grantor in hand paid by said grantee, the receipt whereof is hereby acknowledged, has granted, bargained, and sold to the said grantee, and grantee's heirs and assigns forever, the following described land, situate, lying and being in Pinellas County, Florida to -wit: Lot 3, of SECOND ADDITION TO BELL CHEER SUBDMSION, a subdivision according to the plat thereof recorded at Plat Book 33, Page 70, in the Public Records of Pinellas County, Florida. Parcel Identification Number: 24-29-15-06444-000-0030 Together with all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. To Have and to Hold, the same in fee simple forever. And the grantor hereby covenants with said grantee that the grantor is lawfully seized of said land in fee simple; that the grantor has good right and lawful authority to sell and convey said land; that the grantor hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever; and that said land is free of all encumbrances, except taxes accruing subsequent to December 31, 2010, In Witness Whereof, grantor has hereunto set grantor's hand and seal the day and year first above written. DoubleTimeo PINELLAS COUNTY FI -OFF. REC. BK 17345 PG 373 Signed aled and delivered in our presence: eal) W' e N e) Kara M. Rossewey Witness Na e: Tai. ^ nc State of Florida County of Pinellas The foregoing instrument was acknowledged before me this 29th day of A Rossewey, who [j are personally known or [X] have produced a driver's 1. [Notary Seal] Notary %J FRANCES 0. JACKSON MY COMMISSION # DD 834624 EXPIRES: February 18, 2013 ;F o, Bonded Thru Notary Public UnderwiOrs 2011 by Timothy J. Rossewey and Kara M. as identification. My Commission Expires: Warranty Deed - Page 2 DoubleTimee Annexation Map Request Planner Name: Kyle Brotherton Case Number: ANX2016-05018 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 ❑ Legal Descriptio (warranty deed or urvey) - to be hand delivered ® Map with Propos Site Hi d ® EDR - no hard copies submitted - all submission material is accessible through Accela Location & Right -of -Way Language (for Ordinance Title) Location: Generally south of Druid Road, east of South Hercules Avenue, north of Lakeview Road, and west of South Belcher Road. Right -of -Way [EN,GINEE'RING'INSERT ROW DESCRIPTION OR -N/A HERE] PROVIDED LEGAL DESCRIPTION VERIFIED BY: Mahony, PSM, MAP NAME Owner(s): Multiple Owners Case: TeclAnoloby Manager A N X2016-05018 2112 Bell Cheer Drive Property 0.824 Site: 2138 Bell Cheer Drive Size(Acres): 2196/2198 Bell Cheer Drive ROW (Acres): Land Use Zoning 24-29-15-06444-000-0030 PIN: 24-29-15-06408-000-0090 From : RL R-3 24-29-15-06408-000-0010 To: RL LMDR I Atlas Page: I 308B