ANX2016-07020`Clearwater
0�
12154 BELL CHEER DR
;ANX2016-07020
2154 Bell Cheer Drive - Multiple Owners
[Zoning: f AbrAl 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: $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): Di T. Ly
MAILING ADDRESS:
8868 Christie Drive, Largo, FL 33771-6407
PHONE NUMBER:
727-656-9402
EMAIL:
dilY22@aol.com
AGENT OR REPRESENTATIVE:
MAILING ADDRESS:
PHONE NUMBER:
EMAIL:
ADDRESS OF SUBJECT
PROPERTY:
? 53.4
PARCEL NUMBER(S):
24-29-15-06408-000-0060
LEGAL DESCRIPTION:
Bell -Cheer Sub Lot 6
CURRENT CITYSERVICES:
REQUESTED CITY SERVICES.
(select all that apply)
SANITARY SEWER
X SANITARY SEWER
SOLID WASTE/
RECYCLING
SOLID WASTE/
X RECYCLING
pv: _ 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 02/16
J
:Clearwater
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: 0.24 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 Residence
Single Family Residence
ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY?; YES ❑ NO
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 LS�� day of
9 l- . 2te1 .by
:Tl:i who is ersonally know as
1/0. produced as identification.
Signature of property owner or eprese ative
rria�'h'ry/9k A L. GONZALES
=R: Fs Commission# FF 188814 Notary public,
F expires January 12, 2019 My commission expires: Ta,)jAwQ
Signature of property own X7019
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
`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/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:/Igis.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 02116
LL 1-1Ciearwater-... ....
°
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 02/16
01
Clearnater
Planning & Development Department
Petition for Annexation
PROPERTY OWNER (PER DEED): Di T. Ly
MAILING ADDRESS: 8868 Christie Drive, Largo, FL 33771-6407
PHONE NUMBER: 727-656-9402
EMAIL: dily22@aol.com
AGENT OR REPRESENTATIVE:
MAILING ADDRESS:
PHONE NUMBER:
EMAIL:
OTHER PERSONS HAVINGANY OM
NAME: _
INTEREST IS: _
SPECIFIC INTEREST HELD:
Disclosure Statement
_. .._........... .. --.1---l'.. .1
IERSHIP INTEREST IN THE SUBJECT PROPERTY:
DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY?
CONTRACT IS:
PARTIES INVOLVED — NAME:
NAME:
ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY?
PARTIES INVOLVED — NAME:
NAME:
ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY?
PARTIES INVOLVED — NAME:
NAME:
YES / NO
PHONE NUMBER:
PHONE NUMBER:
YES
✓ NO
PHONE NUMBER:
PHONE NUMBER:
YES
NO
PHONE NUMBER:
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 ( S4�` day of
�ZU✓2—t)t- , t) l ( by
-D Tr L- Y o is personally known s
producgd as identification.
Signature of property owner or retresentati
�r i►G,�,.
'-- mg DEENA L. GONZALES
_*.s4! Commission# FF 188814 Vary blic, exrmarn�T"ga"1 2019
2,2019
ssion expires:
Signature of property owner or representative
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865
Page 5 of 7 Revised 02116
Planning & Development Depart> ent
arwaterPetition for
Annexation
Affidavit to Authorize Agent/Representative
1. Provide names of all property owners on deed —PRINT full names:
Di T. Ly
2. That (I am/we are) the owner(s) and record title holder(s) of the following described property:
2154 Bell Cheer Drive /
3. That this property constitutes the property for which a request for (describe /reUIst):
Annexation of single family residence
4. That the undersigned (has/have) appointed and (does/do) appoint:
as (his/their) agent(s) to execute any petitions or other documrents necessary to affect such petition;
5. That this affidavit has been executed to induce the City of learwater, 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 cert/ify that the foregoing is true and correct.
Property Owner
Property Owner
Property Owner
Property Owner
STATE OF FLORIDA, COUNTY OF PINELLAS
BEFORE ME THE UNDERSIG ED, AN.OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON
THIS DAYOF 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 SeaStamp 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 02116
LL ,
o v' Planning & Development Department
C arwater
Petition for Annexation
Suunlemental Statement
PROPERTY OWNER (PER DEED): Di T. Ly
MAILING ADDRESS: 8868 Christie Drive, Largo, FL 33771-6407
CITY OF CLEARWATER CASE
NUMBER:
/we, iJ ; I. k./
[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:
X 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 !S,*'�- day of
Z-6 (('P.b
L-
�his personally know as
produced as identification.
Signa re of property owner (indiv' ual or au orized
representative of corporation, pa nership or of er
entity) A L. GONZALES
:.� Commission# FF 188814Not ry public,
r Expires January 12 2019 ,, mmission expires: ul4t�✓moi' 12
Signature of co -property own
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
0
I -Clearwater
U
42154 BELL CHEER DR
ANX2016-07020
2154 Bell Cheer Drive - Multiple Owners
Zoning: IM Q TL 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, INCOMP1ETE.f,)RANrORPEr_.T.INF0$MAT:I.ON.MAYJAW--J-1 !�TF YOUR APPUCAT•ION—
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): Perlat Nelaj and Drita Nelaj
MAILING ADDRESS: 3 Grey Ter, Woodland Park, NJ 07424-2903
PHONE NUMBER: 973 -256 -5917(H);973 -768-6692(C);
EMAIL: Pd256@aol.com
P
AGENT OR REPRESENTATIVE:
MAILING ADDRESS:
PHONE NUMBER:
EMAIL:
ADDRESS OF SUBJECT
PROPERTY: 2130 Burnice Drive, Clearwater, FL 33764
PARCEL NUMBER(S): 24-29-15-31050-000-0120
LEGAL DESCRIPTION: Glen Ellyn Estates Lot 12
CURRENT CITY SERVICES: SANITARY SEWER SOLID WASTE WATER
REQUESTED CITYSERVICES: , X SANITARY SEWEk . X SOLID WASTE
,(select all that apply)` • j
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-6624567; Fax: 727-5624865
Page 1 of 7 . ' ` Revised 04/15
o �Planning & Development Department
Akarwater - ' for
�. Petition o 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):
REQUESTED (CITY):
SITE AREA: 0.355
Residential 'Low (RL)
Residential Low
ZON1111G DISTRICT " . -. - - _^ r,;•u_:, r.t:...::, ar,;; r ,-•. A x,� t; z: r .,. .,✓xti
PRESENT (COUNTY): R-3, Single Family Residential
REQUESTED (CITY): Low Medium Density Residential (LMDR)
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): Single Family Detached Dwelling
Proposed (new use, if any';-
plus
ny;plus existing if to remain): Single Family Detached Dwelling
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
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 ND day of
by
1_411A
P�' tA,-1 LLAT XJDA VrA IVE—L4o is personally known/has
Produced NJ' lri2/VF/t_�.l�Ef1lSES as identification.
Signature of property owner or representative
Sign ture of property owner or r7elentative
Planning & Development Department, 100 S.
Page 2 of 7
ti
F;My commission4 Ist
C7
• e�p•�•8ne��e�a'rwatR�,rf�,�
i
STEPHEN R. ELDRIDGE
I.D. # 2407855
Tel: 727-562-4567; Fax: 727-562-0865
Revised 04115
0
>1 earwater 1.1,1.. f Planning & Development Department
Petition for Annexation
0
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 ihaving 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 :'l'1M the -City's Coil itiuni tji
❑ 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 toL 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://kis.pinellascounty.org/public kis/. 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/pwa/engi n%pu bl i6aiions/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://gishttp://gis.pinellascounty.org/publicgis//.
Planning & Development Department, 100.S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865
Page 3 of 7 Revised 04/15
Clearwater
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 i6provement(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 04115
o (` + Planning & Development Department
l� _ �a�al�er Petition for Annexation
Disclosure Statement
PROPERTY OWNER (PER DEED): Perlat Nelaj and Drita Nelaj
MAILING ADDRESS: 3 Grey Ter, Woodland Park, NJ 07424-2903
PHONE NUMBER: 973-256-5917 (H); 973-768-6692 (C)
EMAIL: pd256@aol.com
AGENT OR REPRESENTATIVE:
MAILING ADDRESS:
PHONE NUMBER:
EMAIL...._ r . _ _ ._ _ _ ..... ...... .....
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? YESNO
PARTIES INVOLVED — NAME: PHONE NUMBER:
NAME: PHONE NUMBER:
STATE OF FLORIDA, COUNTY OF PINELLAS t,t{{
I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to,es 6f". y,
knowledge and authorize City representatives to visit and photograph the property described in this application. <`'' F, '-. a ` . N,
Sworn to and subscribed before me this day of
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Zproduced A)J 1A_1VQ , de tificatio�_
Signat re.of property owner,or regr..esentativ Lea
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�r ii.I Notary pu ic, tT • - NOTARY NBUC OF NEW JERSE If
My commission expires:1A I 940785-K
Signature o operty owner or represe ive My COMMWN E*M 41271202
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-662-4567; Fax: 727-562-4865
Page 5 of 7 Revised 04115
i,
l.'
Xlearwater Planning & Development Department
- ' for Petition o An�exation
Affidavit to Authorize Agent/Representative
1. Provide names of all property owners on deed -PRINT full names:
Perlat Nelaj Drita Nelaj
2. That (I.am/we are) the owner(s) and record title holder(s) of the following described property:
2130 Burnice Drive /
_._.. ..,_3__ That_this-properxyfr-Qnstit4ites the. property.for-w+hic 4, a-requestf9r,(,d'66, equAst);.. �..
Annexation of single family detached dwelling
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 Cityrepresentatives 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 the foregoing ' tr nd correct.
Property Owner Property Owner
Property Owner r/ Property Owner
BEFORE ME THE UN
THIS,., & A?n
�F iAfr
DEPOSED /�IAYS
STATE OF FLORIDA, COUNTY OF PINELLAS
DERSIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDAVON" ,r [/)1' •^,,A
Sa `4>I�) • J,0 - Y '
DAY/0F'4/JC PER NL•L'Y APPEO.ED
D 21 TR WHO HAVING BEE 1 T DULY SWORD
G
THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT H�' S13E%&lGNM. d �Q
C12 19 o
NotaryS/e/l/Starnp. A} T ~;
Notary Public Sid PEEN R. EL RIEG,w_�
JE�SEY
My Commission Expires: NOTARY PUBLIC OF NEW I.D. 0-2407855
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-5624567; Fax: 727-562-4865
Page 6 of 7 Revised 04115
o , Planning & Development Department
lorwate
r Petition for Annexation
Supplemental Statement
PROPERTY OWNER (PER DEED): Perlat Nelaj and Drita Nelaj
MAILING ADDRESS: 3 Grey Ter, Woodland Park, N107424-2903
CITY OF CLEARWATER CASE
NUMBER:
I/we,
[insert names of all property owners), hauina filPcj„a Petition fArArnaxacscr regarding the abdve property/ Lase n�iiiber;'
grant consent, agree and acknowledge that the City of Clearwater may immediately or at a later time process fhe 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:
X 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.
0 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 eg,ree 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 th of y!
11'
knowledge and authorize City representatives to visit and photograph the property described in this application. 0
ri
Sworn to. and subscribed before me this a
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r
'PEALP-r /1iCL i $c ?�PL K4 E` wFio is p kn4n/his
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produced N_T D21 VOL- kn=�*n,
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Signature of property owner (individual or author' ed
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4.;
representative of corporation, partnership or of, er ,��.,QQ ���••'•.....••'�;r,
entity)
Notary blic, ITI EN. R. ELDRINICOJ
My commission expires: WfMY_PJM0FKW
Signature of cb property owner I.W. * Aqui ago=
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865
Page 7 of 7 Revised 04/15
Annexation Map Reques
Planner Name: Kyle Brotherton
Case Number: ANX2016-07020
Date Request Submitted: 711116
Date Requested for: 7/16/16
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 Descripti =antyr survey) - to be hand delivered
® Map with Proposed Site Highlighted
® 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:
PROVIDED LEGAL DESCRIPTION VERIFIED BY:
MAP NAME
Owner(s): Multiple Owners Case: ANX2016-07020
Property 0AN,
Site: 2130 Burnice Drive Size(Acres):
2154 Bell Cheer Drive
ROW (Acres):
Land Use Zoning
PIN: 24-29-15-31050-000-0120
24-29-15-06408-000-0060
From : RL R-3
To: RL LMDR ( Atlas Page: I 308B