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ANX2016-08025, ANX2016-08026, ANX2016-08027.N o� C earwater 0 02130 BELL CHEER DR IANX2016-08025 30 Bell Cheer Drive - Kathleen D. King ning: 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. 0 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): Kathleen D. King MAILING ADDRESS: 4930 NW 55th Street, Tamarac, FL 33319 PHONE NUMBER: 954-990-6661 EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 2130 Bell Cheer Dr PROPERTY: PARCEL NUMBER(S): 24-29-15-06426-000-0010 LEGAL DESCRIPTION: Bell -Cheer Sub 1't Add Lot 1 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: 727-5624865 Page 1 of 7 Revised 03/16 Xlearwater 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: 0.235 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 units) I, Single Fami Single Family �GS 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. Swor to and subscribed before me this / day of Y 11,by c ho is rsonally own/has prq%luced as identification. re of property owner or BARBARA A. CALISANTI Notary public, Notary Public - State of Florida My Comm. Expires Aug 7, 2016 My commission expires: % 316 i r oug ational Notary Assn. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 2 of 7 Revised 03116 °C.0earwater 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: �3 Ll Signed and sworn (notarized) disclosure of interest statement (form attached).r z ❑ If th property is not a platted lot of record, a current survey identifying the dimensions, area and location of the pr erty having been prepared, signed and sealed by a land surveyor currently registered in the State of Florida within tfie most recent 12 months. ❑ If de elopment is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the an exation, requisite site plans, plat, and engineering plans shall be submitted. City staff will review proposed plans -to flet mine their compliance with the City's Community Development Code. L3 T. rms of a proposed Agreement to Annex, if any. ❑ IfXe proposed annexation requires a change in the land use classification and zoning category assigned to the operty, a justification for such change must be submitted in writing. If the requested. zoning is not consistent with the Future Ladd Use Map of the City of Clearwater Comprehensive Plan, the applicant will be required to file a companion application to amend the map. ❑ Pro of ow s ' ,(e.g., copy of deed, title insurance policy, or other instrument demonstrating ownership). ❑ If co ection 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 app ' ant is designating an agent/representative to work with City, applicant must provide notarized Affidavit to Au rite 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. O PAR L NUMBER (Parcel I.D. Number) can be found on the Warranty Deed. It can also be found by searching the Pix ellas County Property Appraiser's Office website at www.pcpao.org (search database by address). ❑ L;eil GDESCRIPTION can be found on the Warranty Deed. It can also be found by viewing the property record online at t Pnellas County Property Appraiser's Office website at www.pcpao.org. ❑ FUT RE LAND USE PLAN DESIGNATION (COUNTY) can be found by viewing a Property Report using Pinellas County's Pub c GIS Viewer available online at h_ttp://Ris.pinellascounty.org/public gis/. Search by property address or Parcel I.D. N tuber and report will appear. ❑ FUTU LAND USE PLAN DESIGNATION (CITY) is typically the same as the land use designation in Pinellas County, unless app 'cant 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 Itis/. ❑ 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.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 Clearwater ATTENDANCE AT PUBLIC HEARINGS Planning & Development Department Petition for Annexation Information for ADDlicants 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 r 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 Busupon 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 0 C earwater U PROPERTY OWNER (PER DEED): Kathleen D. King Planning & Development Department Petition for Annexation Disclosure Statement MAILING ADDRESS: 4930 NW 55" St., Tamarac, FL 33319 PHONE NUMBER: 954-990-6661 EMAIL: l�lq . " AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS HAVING_ ANY OWNERSHIP INTEREST IN THE SUBJECT PROPER�'Tl(-. � � — — -- -- ----- - NAME: INTEREST IS: SPECIFIC INTEREST HELD: DOES AA CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? YES NO CONTRACT IS: PARTIES INVOLVED—NAME: PHONE NUMBER: NAME: PHONE NUMBER: VRE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPER 7TY YES NO PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: fARE� 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. Swor o and ubscribed before me this / .� day of by who ' personal) own/has p 9duced If as identification. Signature of property o neo ,q A A A. CALISANTI Notary Public - State of FI w, :P My Comm. Expires Aug 7. 2 tary public, '•''j;oscLd;A�` Commission # EE 190316 Bonded Through National Notary Assny commission expires.--I 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 03/16 o� Planning & Development Department 11 Ci�arwater _,_ Petition for Annexation � Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed —PRINT full names: Kathleen D. King 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 2130 Bell Cheer Drive 3. That this property constitutes the property for which a request for (describe request): Annexation in order to receive solid waste and sanitary sewer service from the City. 4. Th a ""he undersigned (has/have) appointed and (does/do) appoint: as (his/their) agent(s) to execute any petitions or other documents necessary to affect such petition; 5. That this affidavit has been executed to induce the City of Clearwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by City representatives in order to process this application and the owner authorizes City representatives to visit and photograph the property described in this application; 7. That (1/we), the undersigned authority, hereby certify that the foregoing is true and correct. Kathleen D. King t Prop rty Owner Property Owner Property Owner BEFORE ME THE UNDERSIGNE THIS /Z 4;6 DAY OF 1 D AWQ§A (AS ATId4LTq*W$HE Notary Public - State of Florida My Comm. Expires Aug 7, 2016 Commissio Bonded Throixtl!ILb'tarAkAiii Notary Seal/Stamp Planning & Page 6 of 7 OTA Property Owner STATE OF FLORIDA, COUNTY OF PINELLAS OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON 0 / Cv . PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN LLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. L4 My Commission Notary Public Signature Q,epartrtient,00 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Revised 03/16 Clearwater PROPERTY OWNER (PER DEED): MAILING ADDRESS: CITY OF CLEARWATER CASE NUMBER: Kathleen D. King 4930 NW 55` St., Tamarac, FL 33319 Planning & Development Department Petition for Annexation Supplemental Statement I/we, Kathleen D. King [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., a . Sworn -t and subscribed before me this �/ �2 �-� day of d5V V b ho is 6rsonallv knbwn/has - - - - - produced as identification. Signature of prop representative of entity) Signature of co -property owner iMdpgrt3-WpcorSWh@F Florida My Comm. Expires Aug 7. 2016 Commission # EE 190316 Bonded Through National Notary Assn. Notary public, My commission expi 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 Clearwater 2130 BELL CHEER DR ANX2016-08025 2130 Bell Cheer Drive - Kathleen D. King 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: $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): Lloyd Charles, III & Zemma Charles MAILING ADDRESS: 2192 Bell Cheer Drive, Clearwater, FL 33764 PHONE NUMBER: 727-433-0946 EMAIL: zemzemma@yahoo.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 2192 Bell Cheer Drive PROPERTY: ,PARCEL NUMBER(S): 24-29-li5-06408-000-0011 LEGAL DESCRIPTION: Bell -Cheer Sub W 90 Ft of Lot 1 CURRENT CITY SERVICES: SANITARY SEWER SOLID WASTE WATER REQUESTED CITY SERVICES: x SANITARY SEWER x SOLID WASTE WATER (select all that apply) r" Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 1 of 7 Revised 03116 C learwater 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) 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 Single Family 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 applicat' n. gl Sw n to and subscribed before me this day of u PU by p Zemtm i,fAa P kswho isqm erso /has produced.,��LQ,>�ion. rty owner or representative r -,4t r No public, My commission expires: of property owner or representative —.,0 —: * f`FFW797 I, Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 2 of 7 Revised 03/16 ° 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://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 '.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 03116 Planning & Development Department Clearwater =Petition for Annexation U Disclosure Statement PROPERTY OWNER (PER DEED): Lloyd Charles, III & Zemma Charles MAILING ADDRESS: 2192 Bell Cheer Drive, Clearwater, FL 33764 PHONE NUMBER: 727-433-0946 EMAIL: zemzemma@yahoo.com 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 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 application. Sworn to and subscribed before me this �.day of li rou Sf ori y has produced ��Q'o�MMn@�s9•• ion. Signatof property owner or representative 11 N, ublic:99 o p My commission expires: Q 2 ••'I:r:` �":eB::•F�O��•," Sig t e of property owner or representative"M11011tllI11-W0 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 5 of 7 Revised 03/16 Clearnater Planning & Development Department Petition for Annexation Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed —PRINT full names: Lloyd Charles, III Zemma Charles 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 2192 Bell Cheer Drive, Clearwater, FL 33764 3. That this property constitutes the property for which a request for (describe request): Annexation in order to receive solid waste and sanitary sewer service from the City. 4. That the undersigned (has/have) appointed and (does/do) appoint: as (his/their) agent(s) to execute any petitions or other documents necessary to affect such petition; 5. That this affidavit has been executed to induce the City of Clearwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by City representatives in order to process this application and the owner authorizes City representatives to visit and photograph the property described in this application; 7. That (I/we), the i ed authority, hereby certify that the foregoing is true and correct. Lloyd Charles, III Zemma Charles rty rty Owner STATE OF FLORIDA, COUNTY OF PINELLAS Property Owner Property Owner BEFOREdE THE UNDERSIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON THIS/1111111 DAY OF �fi( �l� S� Gq0 �C� PERSONALLY APPEARED sf (rr oki Zexfm WHO HAVING BEEN FIRST DULY SWORN AND PAJ HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. •.� co +IFF 066797 y§14dmIC Zd� -4.4 �1L9 OU4505-�4 Notary Public SignatLffe Notary Seal/Stamp My Commission Expires: /2/-Z oP-0 / 7 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): Lloyd Charles, III &Zemma Charles Planning & Development Department Petition for Annexation Supplemental Statement MAILING ADDRESS: 2192 Bell Cheer Drive, Clearwater, FL 33764 CITY OF CLEARWATER CASE NUMBER: I/we, _Lloyd Charles, III & Zemma Charles [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 applicatio Sworn to and subscribed before me this '�2 day of as produced Signature of property owner (individual or authorized representative of corporation, partnership or other entitv)„ _ Not public, My commission expires: 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 AWL Xnexation Map Request Planner Name: Kyle Brotherton Case Number: ANX2016-08025 Date Request Submitted: 8/3/16 Date Requested for: 8/17/16 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 dee or survey) - to be hand delivered ® Map with Proposed i ighted ® EDR - no hard copies submitted - all submission material is accessible through Accela Location & Right-of-Way Language (for Ordinance Title) Location: Located on the north side of Bell Cheer Drive approximately 150 feet west of Belcher Road and 830 feet west of Belcher Road. Right-of-Way: [ENGINEERING INSERT ROW DESC PTION OR N/A HERE PROVIDED LEGAL DESCRIPTION VERIFIED BY: CL-18^ jqtkb K Thomas Mahony, PIM, Gtgralgic Techno ogy onager MAP NAME Owner(s): Kathleen D. King Case: ANX2016-08025 Lloyd Charles III & Zemma Charles Property 0.518 Site: 2130 Bell Cheer Drive Size(Acres): 2192 Bell Cheer Drive ROW .(Acres): Land Use Zoning PIN: 24-29-15-06426-000-0010 24-29-15-06408-000-0011 From : RL R-3 To: RL LMDR Atlas Page: 3088 ANX2016-08026 3041 Merrill Avenue Becky L. Foy DRC: 9/1/2016 CClst: 10/20/2016 CC2nd: 11/3/2016 Ordinance #s: CAs[ =16 �� sz. -16 (�Cf s3 -16 283A ,-_ earwawr 0 3041 MERRILL AVE ANX2016-08026 3041 Merrill Avenue - Becky L. Foy Zoning: Low Medium Density Atlas #: 283A -J .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): Becky L. Foy MAILING ADDRESS: 3041 Merrill Avenue, Clearwater, FL 33759-3450 PHONE NUMBER: 727-687-9031 EMAIL: bfoy34@vahoo.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT • PROPERTY: 3041 Merrill Avenue, Clearwater, FL 33759-3450 PARCEL NUMBER(S): 09-29-16-45144-009-0080 LEGAL DESCRIPTION: Kapok Terrace 1st Add Blk I, Lot 8 CURRENT CITY SERVICES: REQUESTED CITY SERVICES: (select all that apply) SANITARY SEWER X SANITARY SEWER SOLID WASTE/ RECYCLING SOLID WASTE/ X RECYCLING X 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 `Clearwater 0 Planning & Development Department Petition for Annexation Data Sheet PLEASE ENSURE THAT THE FOLLOWING INFORMATION IS FILLED OUT, IN ITS ENTIRETY. FAILURE TO COMPLETE THIS FORM WILL RESULT IN YOUR APPLICATION BEING FOUND INCOMPLETE AND POSSIBLY DEFERRED UNTIL THE FOLLOWING APPLICATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY): Residential Low (RL) REQUESTED (CITY): Residential Low (RL) ZONING DISTRICT PRESENT (COUNTY): Residential Single Family (R-3) REQUESTED (CITY): Low Medium Density Residential (LMDR) SITE AREA: 0.19 acres SIZE OF DEVELOPMENT: Existing: Proposed: 1 unit 1 unit (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 No ARE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY, YES IF YES, PLEASE LIST/EXPLAIN: STATE OF FLORIDA, COUNTY OF PINELLAS • /1 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 0 day of . by 1.k,uj who is personally known/has I'V propepty owner or representative Signature of property owner or representative produ NOT -fry PUNIC, My commission expires <1L as identification. KATYA WATELSKI NOTARY PUBLIC Comm# EESMIS 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://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://Ris.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 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 oz� Planning & Development Department C_earwater `_ Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Becky L. Foy MAILING ADDRESS: 3041 Merrill Avenue, Clearwater, FL 33759-3450 PHONE NUMBER: 727-687-9031 EMAIL: bfoy34@vahoo.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: .OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: _ �— ----- NAME: — ---- — - — — INTEREST IS: SPECIFIC INTEREST HELD: OES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY YES X NO CONTRACT IS: PARTIES INVOLVED—NAME: PHONE NUMBER: NAME: PHONE NUMBER: FARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? YES X NO PARTIES INVOLVED— NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PRO 7PERTY X YES NO PARTIES INVOLVED— NAME: Wells Fargo- Mortgage 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 --Z �, - 0 day of Signatu fe(ofpropertybwner or representative Signature of property owner or representative produced . by who is personally known/has as identification. Notary public,' KATY t-WATELSI NOTARY PUBLIC My commission expires: AN-QTAMrW=1fV21 Comm# EE835218 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 oPlanning & Development Department C earwater Petition for Annexation Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed -PRINT full names: Becky L. Foy 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 3041 Merrill Avenue 3. That this property constitutes the property for which a request for (describe request): Annexation of single family home 4. That the undersigned (has/have) appointed and (does/do) appoint: as (his/their) agent(s) to execute any petitions or other documents necessary to affect such petition; 5. That this affidavit has been executed to induce the City of Clearwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by City representatives in order to process this application and the owner authorizes City representatives to visit and photograph the property described in this application; 7. That (1/we), the Lmdersigned authority, hereby certify that the foregoing is true and correct. Properly 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 - DAY OF PERSONALLY APPEARED � i WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS CWITHE AFFIDA THAT HE/SHE SIGNED. 6 KATYA WATELSIKI NOTARY PUBLIC STATE OF FLORIDA . COMM#EE835218 Notary Public Signature Expires 8/16/2016 I I Notary Seal/Stamp My Commission Expires: —i, L W1 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 6 of 7 1 Revised 02/16 °(learwater Planning & Development Department Petition for Annexation Supplemental Statement PROPERTY OWNER (PER DEED): Becky L. Foy MAILING ADDRESS: 3041 Merrill Avenue, Clearwater, FL 33759-3450 CITY OF CLEARWATER CASE NUMBER: I/we, I J fe,,KA4 [insert names of all prope y 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 nto,�and subscribed before me this 0-0 day of 1'►�`CLq" .by "&C./�1 � who is personally known/has produced t U`Q YS UC.,l, " 3[-, as identification. Sig at a ofoeo erty ner (individual or authorized representaticororation, partnership or other entity) Notary public, KATYA WATEL3KI My commission expires:�� NOTARY PUBLIC Signature of co -property owner SIAI OFF DA Comm# EEMMS 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 nnexation Map Request Planner Name: Kyle Brotherton Case Number: ANX2016-08026 Date Request Submitted: 8/3/16 Date Requested for: 8/17/16 Maps Needed ® Location Map ® Aerial Photograph zProposed Annexation ® Future Land Use Map ® Zoning Map ® Existing Surrounding Uses Map ® 2" x 2" PDF Map (for Newspaper) Required Documents ❑ Legal Description lwarranty deed 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: Located on the south side of Merrill Avenue approximately 450 feet west of McMullen Booth Road. Right -of -Way: [ENGINEERING INSERT ROW DESCRIPTION OR N/A HERE] WPROVIDED LEGAL DESCRIPTION VERIFIED BY: Z4t Tho as Ma ony, PSA, Geo raphi echnolO& Manager MAP NAME Owner(s): Becky Foy Case: ANX2016-08026 Property 0.186 Site: 3041 Merrill Avenue Size(Acres): ROW (Acres): Land Use Zoning PIN: 09-29-16-45144-009-0080 From : RL R-3 To: RL LMDR Atlas Page: 283A ANX2016-08027 1846 Pineland Drive Jeff Bagby DRC: 9/1/2016 CClst: 10/20/2016 CC2nd: 11/3/2016 Ordinance #s: -16 -16 SJ 5.b -16 Ili 1846 PINELAND DR -- ANX2016-08027 EARWA TER '.. (1846 Pineland Drive -Jeff Bagby Zoning: Low Medium Density Atlas #: 260B 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 To Be Completed By Property Owner: PROPERTY OWNER (PER DEED): Jeff Bagby MAILING ADDRESS: 1846 Pineland Drive, Clearwater, FL 33755 PHONE NUMBER: 727-641-2250 EMAIL: AGENT OR REPRESENTATIVE: NONCONTIGUOUS (TYPE A ENCLAVE) MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: 1846 Pineland Drive, Clearwater, FL 33755 PARCEL NUMBER(S): 03-29-15-36666-002-0210 LEGAL DESCRIPTION: Harbor Vista Block B, Lot 21 and E % of Vacated Playground Lying W of Lot 21 SOLID WASTE/ CURRENT CITY SERVICES: SANITARY SEWER RECYCLING x WATER SOLID WASTE/ REQUESTED CITY SERVICES: x 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 Planning & Development Department At VLii..LY.VJ .;!•VJR AAAA L.AY WV�� w.s. :a.. °.., w.;-s.'.��r "a,... a.rx. }ar .4a e.s,a..... .*:i� .,.s.?a - .... .�.,...........�.r .. `�.. ... DEVELOPMENT DEPARTMENT BY NOON ON THE SCHEDULED DEADUNE DATE. ALL. PAGES WITHIN MUST BE:SIGNED BY. ALL PROPERTY OWNERS LISTED ON THE DEED. % .1.'= gg•;.: t �c: ?_g ,Y3 .. SUBMITTED FOR REVIEW RY THE DEVELOPMENT REVIEW COMMITTEE. o DECEPTIVE, INCOMPLETE OR, INCORRECT: INFORMATION.MAY INVALIDATEYOUR APPLICATION.' COMMUNITY DEVELOPMENT:CODE IMPACT FEE/ASSESSMENT FEE: TBD Information on Impact Fees or Assessment Fees is available.from' the City of Clearwater Engineering' Department (562-4747). :TYPE Of ANNEXATION! x CONTIGUOUS NONCONTIGUOUS tTYPE A ENCLAVE) .;moo Be;Completed By -Property Owner. CURRENTCITYSERVICES_ SANITARY SEWER RECYCLING x WATER. REQUESTED CITYSERWCES; x. SANITARY SEWER x . RECYCLING „ WATER (select all that apply): rfrnrtutg s WeVeto prnern r.repaIUnetu, iuu b: iwptee avenue t reatvrater, i,L 44rao;', ren rc r oo'c_400r; `raa: rtroot+iau6 Page 1 of 7 ReAsed 02116 CLEARWATER BRx, it TD imkunnm-RAY To mAot 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) REQUESTED (CITY) ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): SITE AREA: 0.169 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residential square footage) Residential Urban (RU) Residential Urban R-4 One, Two & Three 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 units} rental? �._.—.,.. . w. ARE THERE A_NY ACTI_VEjOPEN PEfiIVIITS FOR THE PROPERTy, Wll'HIN4PINELLAS COUNTY IF YES, PLEASE LIST/EXPLAIN: Single Family Residential Single Family Residential YES ❑ NO ❑ 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 day of . by who is personally known/has produced as identification. Signature of property owner or representative Notary public, My commission 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 2 of 7 Revised 02/16 Planning & Development. Department 'Petit(on-.tor Annexation Ucll.d J11CC :. .,..,..:. P,..�€- a•'.q-. ,' ��, `� a$ '-_�y;E E. y;�s f��s <�-. �. r.':3C � e € ,a—':. .i-cffx. �, � ' , FORM WILL RESULT IN YOUR APPLICATION BEING FOUND INCOMPLETE AND POSSIBLY DEFERRED UNTIL THE FOLLOWING APPLICATION CYCLE. PRESENT (COUNTY): . Residential Urban (RU) REQUESTED (CITY): Residential Urban (RU) PRESENT (COUNTY): R-4. one, Two. & Three Family Residential: REQUESTED (CITY): low Medium Density Residential (LMDR) SITE AREA: 0:169 acres STATE OF FLORIDA,. COUNTY OF PINELLAS I (we), the undersigned, acknowledge that all representations made in this application are true: and acctlr he best of my knowledge and authorize City representatives to visit and photograph the:.pToperty described in this applir at " Sworn to su scribed before me this -.,day of ' -----': by who is zI1 as identification, LEAR' ATER, -5PJ1MU AND 3LNUM-1.m, My To Mck 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 Planning & Development Department Petition for Annexation Subbuttal package instructions & Checklist :.UY• p'iiA`f.'.!li flX!'/} 'ice llili...!4.V�Ttt,►i.i�. V„Faf>f Otatli"i l;fW1 l.ik .i!'i ":Y siY4t1}�:':M'YAi. U Wi;ii ,�Yi.YA'w ..k i%'!� f'NO'a5'M/S,"s^l ��.ilZF Y Hi+tV'aSft.J;i3t 1!'C4i INCLUDE A SUBMITTAL PACKAGE THAT INCLUDES THE FOLLOWING: ; 0 Signed and sworn (notarized) disclosure of interest statement (form attached). property having been prepared, signed and sealed by a land surveyor currently registered in the'State_of Florida within El If development is to be initiated prior to submission of an annexation petition and/ prior to the effective date of the determine. their compliance with the City's Community Development Code. 0 If the proposed annexation -requires' a change in the land use classification and zoning category assigned to the Future Land Use Map ofahe City of Clearwater Comprehensive Nan, the applicant will be required to file:a companion D Proof of ownership (e.g_ copy of deed; title insurance policy, or other instrument demonstrating ownership). Petition for Annexation Supplemental Statement ,(form attached). ''«.tr .. moi :..:.....:. ..�:.:b .......b ..,.. i.p�:.y . ��. �..........:-. :.. ...... -r, �rr..�..... ..., ':.....�.. ........�.•.c. Author ze.Agent%Representative (form attached). FOUND ON THE FOLLOWING DOCUMENTS AND/OR ONLINE AT THE FOLLOWING WEBSITES. IF THE APPLICANT IS s :PLANNING AND DEVELOPMENT DEPARTMENT, LONG RANGE'PLANNING DIVISION AT 727-562-4S67. i�: % a,.1�xi ,E� t�-f� s E ` s rs;a Si.. t1:i ;•''1z � �; ,-$ i ¢ � $R` Pinellas County Property.Appraiser's Office website at vw' w%wp .or (search database by address);: the Pinellas County PropertyAppraiser's Office website at' vysr.pcp2o.otg_ T. •.(,�i .. E'. �.';.-<: 3 + +,::' 3 r3'.a° ..i?..s� 5 z . #; A-; ;i €3 Public GIS Viewer available online at http ' s.porietlascolint r}�ar %public-s*Isi. Search by property: address or Parcel .I D Q. ;FUTURE LAND USE PLAN DESIGNATION (CITY) is typically the same as theland usp.designation in Pinellas County, unless D ZONING DISTRICT (CoUNTY).can be found by viewing a' Property Report using Pinellas County's Public GIS Viewer /l•�is.ls.....- scriiinty<cirelpub{#e :Ll ZONING DISTRICT (CITY) can be found by contacting the Planning and Development Department or viewing the','CRy''s e <tl isr»yclearvtaterm/Zoriin,,; O SITE AREA (ACRES) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at;fittp%!€Is' piie3ta�cot"tntV org73'subiec >glsJ Ptanntng 4,Peveldpnient: Department, 100S. Myrtle Avenue, Clearwater, FL 33/66, tel: f21-0652 4561; haX:: f2 f-b6ZdN6L Page of 7.. Revised 02116. f CLEARWATER BBtc rr x-m BEALlnym • mvro B.ACii __.... . - ov 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. , 0 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 Planning& Development Department ;petition :dor Annexation intor nation for Applicants ATTENDANCE AT PUBLIC HEARINGS:: pertains to a property developed or to be developed with one single family dwelling: STANDARDS FOR 'ANNE XATION 0 The proposed annexation wili:impact public services.(e.g., water,aewer;:police, parks,, etc.) O The proposed annexation requires a change in the future land use and zoning classifications assigned to the ❑ Existing:or proposed development is consistent with City regulations.. :[] Terms of aro osed Annexation Agreement, reementif an p p g y, .promotes the City of: Clea rwater:Comprehens/ve Plan: PROPERTY OWNER AGREEMENT u All structures and improvements which are erected upon said property subsequent to the date of this petition .for Page 4 of? Revised 02NS CLEARWATER s B�,x��•YH Planning & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Jeff Bagby MAILING ADDRESS: 1846 Pineland Drive, Clearwater, FL 33755 PHONE NUMBER: 727-641-2250 EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS;HAVING ANYOWNERSHIP 1NTERE$T IIV�THE SUBJEET JPk&RffY: _..__.�. 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 day of by who is personally known/has produced as identification. Signature of property owner or representative Notary public, My commission 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 02/16 Planning & Development Deparftnent Petition for Annexation jj sciosuire statement . . .......... I ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY?. YES NO NAME:_ PHONE NUMBER: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? OPERTY? YES NO as -1- T PHONE NUM 7 NAM'Ez:CA j;& 7 6t;4 ........ . .... Planning.& Development Department, 100 & Myrtle Page:6 of 7 rj- FL 33756, Tel: 727-6624567; Fax: 727-6624866 . W* -8 Rev ised ised 02M6 =nwoopoptYComm F EXPIRES:- tfl?.20i8 a-. BNGF7i 71SID BEAl17YFUL•AAY2U.lifiACH Planning & Development Department Petition for Annexation Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed —PRINT full names: Jaff Bagby 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 146 Pineland Drive, Clearwater, FL 33755 3. That this property constitutes the property for which a request for (describe request): Annexation in order to receive solid waste and sanitary sewer service. 4. That the undersigned (has/have) appointed and (does/do) appoint: as (his/their) agent(s) to execute any petitions or other documents necessary to affect such petition; 5. That this affidavit has been executed to induce the City of Clearwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by City representatives in order to process this application and the owner authorizes City representatives to visit and photograph the property described in this application; 7. That (1/we), the undersigned authority, hereby certify that the foregoing is true and correct. Jeff Bagby 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 DAY OF , PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Public Signature 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 02116 4" Provide names of all property.owners on deed— PRINT full,narnes; Taff Bagby .... . . .......... .............. - ........... - .. ......... ............ - ............. - . .......... ........ That the undersigned (has/have) appointed and (does/do) appoint: Planning a Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33766, Tel: 727-6624667; Fax: 727-662-4866 Page:9 of 7 Revised 02116 snaccrrx�senunriinAYTOBznci� PROPERTY OWNER (PER DEED): Jeff Bagby Planning & Development Department Petition for Annexation Supplemental Statement MAILING ADDRESS: 1846 Pineland Drive, Clearwater, FL 33755 CITY OF CLEARWATER CASE NUMBER: I/we, _Jeff Bagby [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 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 day of by produced Signature of property owner (individual or authorized representative of corporation, partnership or other entity) Notary public, My commission expires: Signature of co -property owner who is personally known/has as identification. 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 [insert names of all property owners], having filed a Petition for Annexation regarding the above property/case: number, application to completion, including adoption and recordation of related Ordinances, without the necessity to further notice my/ourpredecessors in interest. Select One Option Below Which Applies to This Petition for Annexation: u r.(4::•.nu�iu.. v .•ug "vu.>:=».....:•�..J. f �.. •4:..r -.•g ,..., u:.... •..�. wrv.:..F... ... - a.....: w.w: ••v. wiw . w. w% Annexation: or.execute any documents attempting such rescission, and that any attempted rescission shall be of no. force Alru G11 Ga.i. 0 Annexation of Noncontiguous Parcel(s): I/:we understand that this annexation is voluntary, and than we may withdraw 'a. •.s i� i.ts....-:..•,•..i•i� ui.ae•.p,•-cuc .ai'.:': .»-. u�a w::.•r. s c r.��r:.•vir u.y_: i• �.c•a�'vi�,.c.:us sna..:•: aj'» ..:as.:rr': upi»�-a: icr.a: acknowledge, however, that receipt of all sewer, solid waste or other city service is contingent, upon completion of the discontinuance and termination of all City -provided, services. :STATE OF FLORIDA, COUNTY OF PINELLAS f I::(we), the. undersigned, acknowledge that all representations made in this application are true and accurate to:.,. best of my knowledge and authorize City representatives to visit and photograph the property described in this applicatlo s Sworn to ati scribed before me thisT-h- day of y v 3 whoa 'personally ienow has produced asidentification ifre f prdperty%;owner ( iiAjil or authorize est . . tive of corporation, ;partnership or other Ask Tn'nexation Map Request Planner Name: Kyle Brotherton Case Number: ANX2016-08027 Date Request Submitted: 8/3/16 Date Requested for: 8/17/16 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 Descriptiowarranty deed r survey) - to be hand delivered ® Map with Propose g ighted ® EDR - no hard copies submitted - all submission material is accessible through Accela Location & Right-of-Way Language (for Ordinance Titie) Location: Located on the west side of Pineland Drive approximately 400 feet south of Sunset Point Road. Right-of-Way: [ENGINEERING INSERT ROW DElThma�s ION OR N/A HE PROVIDED LEGAL DESCRIPTION VERIFIED BY:8 l4 Mahon , PSM, a phic Tec nology Manager MAP NAME Owner(s): Jeff Bagby Case: ANX2016-08027 Property 0.141 Site: 1846 Pineland Drive Size(Acres): ROW (Acres): Land Use Zoning PIN: 03-29-15-36666-002-0210 From : JAL) R-3 To: R-L-12-u LMDR Atlas Page: 2608