Loading...
The URL can be used to link to this page
Your browser does not support the video tag.
ANX2017-06013
1 �ur+� ANX2017-06013 Address Owner Parcel 809 Glen Oak Ave E. NEWTON, RICHARD V & FRAZIER, ANTWON L 09-29-16-45126-003-0060 907 Glen Oak Ave E. KUCHLE, SEAN P 09-29-16-45126-003-0090 915 Glen Oak Ave E. SAVOY LLC 09-29-16-45126-003-0110 3053 Grand View Ave. SNELLING, SANDRA A 09'29=16=45126-001-0060 3058 Hoyt Ave. JORDAN, DARA J & JORDAN, BENJAMIN 09-29-16-45144-009-0140 3040 Merrill Ave STEWART, SHIRLEY A 09-29-16-45126-001-0110 3077 Merrill Ave. FRITH-CARNABUCCI, LELETHE 09-29-16-45144-009-0020 3136 San Jose St. YANTORNO, JOHN W JR 09-29-16-20808-000-0560 3080 Terrace View DABIRI, MASSOUD MIKE 09-29-16-45126-003-0020 3127 Wolfe Rd.- PRZYBECK, RALPH M 09-29-16-05310-000-0080 DRC: 7/6/17 CClst: 8/16/17 CC2nd: cbv4 nv-p-a �0 << SIG Ordinance #s: q'058' -17 qo5`� -17 lo &o -17 ANX2017- Address Parcel acerage 1 809 Glen Oak Ave E. 09-29-16-45126-003-0060 0.19 2 907 Glen Oak Ave E. 09-29-16-45126-003-0090 0.192 3 915 Glen Oak Ave E. 09-29-16-45126-003-0100 0.16 4 3053 Grand View Ave. 09-29-16-45126-001-0060 0.2 5 3058 Hoyt Ave. 09-29-16-45144-009-0141 0.185 6 3040 Merrill Ave 09-29-16-45126-001-0110 0.198 7 3077 Merrill Ave. 09-29-16-45144-009-0020 0.19 8 3136 San Jose St. 09-29-16-20808-000-0560 0.213 9 3080 Terrace View 09-29-16-45126-003-0020 0.16 10 3127 Wolfe Rd. 09-29-16-05310-000-0080 0.45 I LEARWNfER .. Planning & Development Department Petition for Annexation 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 orAssessment 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): Richard Van Newton and Antwon L. Frazier MAILING ADDRESS: 809 Glen Oak Ave. E. Clearwater FL 33759 PHONE NUMBER: 727-324-7414 EMAIL: aurorainnovations@&Mall.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 809 Glen Oak Ave E. Clearwater FL PROPERTY: PARCEL NUMBER(S): 09-29-16-45126-003-0060 LEGAL DESCRIPTION: KAPOK TERRACE SUB BLK C, LOT 6 SOLID WASTE/ [CURRENTCITYSERVICES:, SANITARY SEWER RECYCLING X WATER SOLID WASTE/ EQUESTEDCITYSER VICES.- X SANITARY SEWER RECYCLING X WATER (select all that apply) Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-5624567; Page 1 of 7 Revised 08.18.2016 ,CLEARWATERPlanning & 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): RL REQUESTED (CITY): RL ZONING DISTRICT PRESENT (COUNTY): R-3 REQUESTED (CITY): Low Medium Density Residential (LMDR) SITE AREA: 0.19 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 0 (e.g., number of units, hotel rooms or non- residential square footage) acres USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; plus existing if to remain): If residential use, is unit(s)', ental? Single Family House n/a NO 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 - ZC) day of A / � I AAAI by / % // ✓� I 4rUJC)1j i1 -14z l r- , who is personally known/has 7 / produced FZaeinA WAV6?S as identification. of p e or re entative Notary public, STATE OF FLORIDA My commission expires: ( `ji/2-0-law Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 3 of 9 Revised 08.18.2016 CLEARWATER Planning & Development Department ��MA,tc.Ffi;�;+IsA.,'� "Ut;t Rtii YFi 6�3f'f1 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): RL REQUESTED (CITY): RL ZONING DISTRICT PRESENT (COUNTY): R-3 REQUESTED (CITY): Low Medium Density Residential (LMDR) SITE AREA: 0.19 acres SIZE OF DEVELOPMENT: Existing: 1 Proposed: 0 (e.g., number of units, hotel rooms or non- residential square footage) USE OF PROPERTY: Existing (currently on site): Single Family House Proposed (new use, if any; plus existing if to remain): n/a If residential use, is units) NO ental? RE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY?; YES n 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 15111 day of fAtIr"A 7,b1-1 . by .9&k4ct� VA4 PtW4-0A who is personally known/ba-s, ptfeducEd-- P"SOAA,1'`1 lc'W Signature of or representative Notary public, My commission expires: V" Signature of property owner or representative Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL Page 2 of 7 as identification. JOHN DALY Cominlssion N FF 971274 Comm. Expires Jun 113, 2020 & through National Notary Assn: cLEARWAT l; 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-S62-4567. ❑ 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://Ris.pinellascounty.ore/public eis/. Search by property address or Parcel I.D. Number and report will appear. ❑ FUTURE LAND USE PLAN DESIGNATION (CITY) is typically the same as the land use designation in Pinellas County, unless applicant is proposing a change (see submittal package requirements for more information). ❑ ZONING DISTRICT (COUNTY) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://eis.pinellascounty.org/public eis/. ❑ ZONING DISTRICT (CITY) can be found by contacting the Planning and Development Department or viewing the City's Zoning Atlas, available online at exteis.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 eis/. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-5624667; Page 3 of 7 Revised 08.18.2016 --')CLEIARV rE Planning & Development Department "tzp'W.`F Petition for Annexation Information for Applicants ATTENDANCE AT PUBLIC HEARINGS 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: 727-5624567; Page 4 of 7 Revised 08.18.2016 PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: Richard Van Newton and Antwon L. Frazier 809 Glen Oak Ave. E. Clearwater FL 33759 727-324-7414 Planning & Development Department Petition for Annexation PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: INTEREST IS: SPECIFIC INTEREST HELD: A CONTRACT EXIST FOR SALE OF THE SUBJECT CONTRACT IS: PARTIES INVOLVED — NAME: NAME: RE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY?; PARTIES INVOLVED — NAME: NAME: Disclosure Statement YES PHONE NUMBER: PHONE NUMBER: ©m YES X NO PHONE NUMBER: PHONE NUMBER: RE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? X YES NO PARTIES INVOLVED — NAME: CITIMORTGAGE, INC. (0770803915-6) PHONE NUMBER: 1-866-272-4749 NAME: CITIMORTGAGE, INC. (0630109266-1) PHONE NUMBER: 1-866-272-4749 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 IS•{' h ' day of by Q%C,h'Mt.O VAAJ who is personally known/has— Signature of projSerty owner or representative Notary public, My commission Signature of property owner or representative w0Uj wk as identification. JOHN DALY Commission +s FF 971274 Planning &DevelopmentDepartment,100 S. Myrtle Avenue, Clearwater, FL 337 , , A#011nm. Expires Jun 18, 2020 Page 5 of 7 ''''�Oi` •� RB�ildihR�9�� Nota y a, ., I�. CLEARWATER Planning & Development Department Z 5)"'�"�W�"1A-w TOM"' Petition for Annexation PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: Richard Van Newton and Antwon L. Frazier 809 Glen Oak Ave. E. Clearwater FL 33759 727-324-7414 Disclosure Statement PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NONE NAME: INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY?i 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 PROPER PARTIES INVOLVED—NAME: CITIMORTGAGE, INC. (0770803915-6) NAME: CITIMORTGAGE, INC. (0630109266-1) YES X I NO PHONE NUMBER: PHONE NUMBER: YES X NO PHONE NUMBER: PHONE NUMBER: X YES NO PHONE NUMBER: 1-866-272-4749 PHONE NUMBER: 1-866-272-4749 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 represe atives to visit and photograph the property described in this application. / I Sworn to and subscribed before me this Zo day of /AA -y 'Zee 0 . by of prjfpgrty owe #ror &J,rt, oto f9-Azi e— who is personally known/has produced r cz%O.A Oe-wmes oCZNs L- as identification. My commission expires: Flip Teak Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562.4567; Page 6 of 9 Revised 08.18.2016 (�CLEARV+VATER Planning & Development Department IZY MAW A"K.M "`"'ImWMA-M Petition for Annexation .11 3U1J VIC11111CIll.dl 3WILC1IMIL PROPERTY OWNER (PER DEED): I Richard Van Newton and Antwon L. Frazier MAILING ADDRESS: 1 809 Glen Oak Ave. E. Clearwater FL 33759 CITY OF CLEARWATER CASE NUMBER: I/we, Richard Van Newton and Antwon L. Frazier, 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: W/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 `Zee day of MA1j 2e.)A`1 by A lsT ;.� o � riz4z, � 2 , who is personally known/has produced PLaa i o a O,L.v e e s Li c EN slC as identification. Signature of pr a owner (individual or a horized representa ' e f rporation, partnershi or other P Temic entity) _ _ ' NOTARY PUBIC My commission expires: d -7/0 EWWO 918/x020 a r f co -p e yo Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 9 of 9 Revised 08.18.2016 +---"')CLEARWATER Planning & Development Department Petition for Annexation Supplemental Statement PROPERTY OWNER (PER DEED): Richard Van Newton and Antwon L. Frazier MAILING ADDRESS: 1 809 Glen Oak Ave. E. Clearwater FL 33759 CITY OF CLEARWATER CASE NUMBER: I I/we, Richard Van Newton and Antwon L. Frazier, 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: IE(Annexation of Contiguous Parcel(s): [/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): [/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. l/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 15 f'h day of "" , Zn 11 . by 9AONA(LO AV uLUAM -,who is personally knowllaas- Signature of property owner (individual or authorized representative of corporation, partnership or other entity) Notary public, My commission Signature of co -property owner as identification. JOWN DALY Notary Public - State of Flofidi - Commission # FF 971274 My Comm. Expires Jun 1"8, 2020 ,OF F� Bonded through National Notary Assn: Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 3 e . , Page 7 of 7 Revised 08.18.2016 A� MAY 2 S 2017 ,,:. I . ELM I(f PLANNING& DEVELOPMENT DEPT Planning & Development Department CITY OF CLEARWATER Petition for Annexation 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: TYPEOFANNEXATION: X CONTIGUOUS NONCONTIGUOUS (TYPE A ENCLAVE) To Be Completed By Property Owner: PROPERTY OWNER (PER DEED): Sean P. Kuchle MAILING ADDRESS: 907 Glen Oak Avenue E, Clearwater, FL 33759 PHONE NUMBER: 687-6476 EMAIL: sean@wydinc.net AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: PARCEL NUMBER(S): LEGAL DESCRIPTION CURRENT CITY SERVICES: 907 Glen Oak Avenue E, Clearwater 33759 09-29-16-45126-003-0090 Lot 9, Block C, Kapok Terrace Subdivision SOLID WASTE/ SANITARY SEWER RECYCLING x WATER REQUESTED CITY SERVICES: x (select all that apply) SOLID WASTE/ SANITARY SEWER x RECYCLING 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 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: 0.192 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residential square footage) Residential Low (RL) Residential Low (RL) R-3 Single Family Residential Low Medium Density Residential (LMDR) acres USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; plus existing if to remain): If residential use, is unit(s) rental? ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? IF YES, PLEASE LIST/EXPLAIN: STATE OF FLORIDA, COUNTY OF PINELLAS Single Family Residential Single Family Residential No 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 !C�(-{'%� day of �� , f?Ot`1 . by 5ce" Kvc.h�Q who is ersonally known as �— produced as identification. ure of property owner or representative Notary pk�yi, My commission expires: h( Signature of property owner or representative Maryann Sargent �..,.a My Commission.FF 229510 � Planning & Development Department, 100 S. Myrtl or n.a eF��/ii56, Tel: 72 562-4567; Fax: 727-562-4865 Page 2 of 7 Revised 02/16 Planning & Development Department �� .•' :i; a (-1 14"!hi ('iP ..T :t-Y.4:.".i:2i 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 Pion, 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.pinellascountV.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 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 Pion. ❑ 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 Pion. 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 PROPERTY OWNER (PER DEED): Sean P. Kuchle Planning & Development Department Petition for Annexation Disclosure Statement MAILING ADDRESS: 907 Glen Oak Avenue E, Clearwater, FL 33759 PHONE NUMBER: 687-6476 EMAIL: _ AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? YES X NO CONTRACT IS: PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE 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 PROPERTY? X YES NO PARTIES INVOLVED — NAME: Mortgage Holder: Cenlar PHONE NUMBER: 877-237-2662 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 b by who is onallykn as �---'' produced as identification. Signature of property owner or representative Signature of property owner or representative Planning & Development Department, 100 S. Myrtle Page 5 of 7 Notary pu 4e n expires: ,. p o� Scc State of Florida My Commlasion 28510 �ft%t 10el: 727-562 567; Fax: 727-562-4865 Revised 02/16 Planning & Development Department " A, """` ""''' Petition for Annexation Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed — PRINT full names: Sean P. Kuchle 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 907 Glen Oak Avenue E, Clearwater, FL 33759 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 (1/we), the undersigned authority, y certify that the foregoing is true and correct. Sean P. Kuchle 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 _ 1.AU 1-�7- , PERSONALLY APPEARED 5e -), e% Kuc'k le 61 WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Seal/Stam U Notary Public Signature y Commission Expires: 1(�-/ �__ Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 6 of 7 Revised 02/16 �+ F w 77 N r Brut rJ , ', ,-:? tst,n, ............ PROPERTY OWNER (PER DEED): Sean P. Kuchle Planning & Development Department Petition for Annexation Supplemental Statement MAILING ADDRESS: 907 Glen Oak Avenue E, Clearwater, FL 33759 CITY OF CLEARWATER CASE NUMBER: I/we, _Sean P. Kuchle [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: 19 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 `q7�7% day of d� c40 Z ? . by who ' personal/ /has produced as identification. Anature of property owner (individual or authorized representative of corporation, partnership or other entity) Signature of co -property owner Notary Y11c, LMy commission expires: M4. •"' P e� Notary Public $�� of_FJodd _ , Maryann Sargent s, �` My Commission FF 229510 rtira Expires 05/11/2019 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 _ CLEARWATER MGM AND BUUMM AMY ro BEACH Planning & Development Department Petition for Annexation 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 OFANNEXATION. CONTIGUOUS x NONCONTIGUOUS (TYPE A ENCLAVE) To Be Completed By Property Owner: � q1-5 -5 PROPERTY OWNER (PER DEED): Savoy LLC MAILING ADDRESS: 924 McMullen Booth Road Clearwater FL 3379 37t-9 PHONE NUMBER: 727-726-8787 EMAIL: rugbazaar@aol.com 6 AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: PARCEL NUMBER(S): 915 Glen Oak Ave E, 09-29-16-45126-003-0110 LEGAL DESCRIPTION: KAPOK TERRACE SUB BLK C, LOT 11 SOLID WASTE/ [CURRENT CITY SERVICES SANITARY SEWER RECYCLING WATER SOLID WASTE/ EQUESTED CITYSERVICES1 SANITARY SEWER RECYCLING WATER (select all that apply) Planning & Development Department,100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 1 of 7 Revised 08.18.2016 _; CLEARWATER �� BRICHTAND SEAITfIFUt.•HAYYOBEA(�I 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): RL REQUESTED (CITY): RL ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): SITE AREA: 0.16 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 0 (e.g., number of units, hotel rooms or non- residential square footage) R-3 Low Medium Density Residential acres USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; plus existing if to remain): f residentialuse, is unit(s ental . Single Family Home n/a RE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY. YES ❑ N19,2]" 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 I s� day of T'&ht 2011 by N( a Ssc,,d who is personally known/has produced 4;L- Drive -r1 La CfAse as identification Signature of property owner or representative �;.•.••.y TANIAVASQUEZ MY COMMISSION 0 GG 021 AgMmt 14- 20A Notary public, ,.a���%*' WwdedTWuNotMPublicWO ti•M ,M My commission expires: Signature of property owner or representative 'R 1Irk 2020 Planning & Development Department,100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562.4567; Page 2 of 7 Revised 08.18.2016 )UL RWATER 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://eis.pinellascounty.org/public eis/. Search by property address or Parcel I.D. Number and report will appear. ❑ FUTURE LAND USE PLAN DESIGNATION (CITY) is typically the same as the land use designation in Pinellas County, unless applicant is proposing a change (see submittal package requirements for more information). ❑ ZONING DISTRICT (COUNTY) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://Ris.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; Page 3 of 7 Revised 08.18.2015 CLEARWATER -•-.`".�_,. �rca�ruvusravruvr..axrTo�ac;� 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: 727-5624567; Page 4 of 7 Revised 08.18.2016 r N _,- I '* �... CLEARWATER M,Q1TJAa,D8WMFM'BMT0BMCH PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: Planning & Development Department Petition for Annexation Disclosure Statement Savoy LLC 924 McMullen Booth Road Clearwater FL 3379 727-726-8787 rugbazaar@aol.com (' Q Vb ,4Z C THER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: INTEREST IS: SPECIFIC INTEREST HELD: OES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPE YES NO CONTRACT IS: PARTIES INVOLVED—NAME: PHONE NUMBER: NAME: PHONE NUMBER: RE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? YES / NO PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: RE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? YES i 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 15'F day of :1XA e . 201'1 . by M&Mpy.j De-& r'- who is personally known/has produced FL- 0r„1-e_,:i U Ccvn se, as identification. Signature of property or representative NoWry public, My commission expires: Signature of property owner or representative TANIAVASOUE2 MY COMMISSIO EXPIRES: August 14, Bonded Thru Notary Public L Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 5 of 7 Revised 08.18.2016 CLEARWATER BBIGHTA MBBA1£fBIR,' BAY TO MCH Planning & Development Department Petition for Annexation Affidavit to Authorize Agent/Representative Provide names of all property owners on deed — PRINT full names: savoy L -LC 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 3. That this property constitutes the property for which a request for (describe request): �e1 Tl-dh 4;y-KNheXAd v✓i 4. That the undersigned (has/have) appointed and (does/do) appoint: t>ofbiri , MpjSSoLAa2. IMiI^-k. as (his/their) agents) 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 Fity representatives to visit and photograph the property described in this application; 7. That (I/ e u r igned thority, he eby certify that the foregoing is true and correct. Property Owner Property Owner Property Owner Property Owner STATE OF FLORIDA, COUNTY OF PINELLAS BEFORE ME THE UNDERSIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON THIS I s+ DAY OF T.,,c Zoll 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. ro1r "z`''sTANIAVASQUEZ ' MY COMMISSION 0 GG 020844 EXPIRES: August 14,2D20 r, fo o Bonded TAN Notary Publk Undenudters Notary Seal/ amp Notary Public Sig4Vure My Commission Expires: $� 1.+ 2020 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 6 of 7 Revised 08.18.2016 q CLEARWATER BRIGtCf AND BFJBJI9NL• BAY TO BEACH Planning & Development Department Petition for Annexation Supplemental Statement PROPERTY OWNER (PER DEED): Savoy LLC MAILING ADDRESS: 924 McMullen Booth Road Clearwater FL 3379 CITY OF CLEARWATER CASE NUMBER: I/we, Savoy LLC 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): 1/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 I s+ day of �w rpt 2-0 1"1 . by Mcnl ioL,d Dn-" r-. . who is personally known/has produced Signature of property owner (individual or authorized representative of corporation, partnership or other entity) J_� Signature of co -property owner FL Dr1verS Uc•e►+st Notary public, v My commission expires: 'If 11-4 12o2J as identification. TANIA VASQUIZ MY COMMISSION # GG 020844 Bonded Tlw Notary Public Planning & Development Department,100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562.4567; Page 7 of 7 Revised 08.18.2016 .ail by Entity Name Florida Limited Liability Com SAVOY LLC Document Document Number L04000058574 FEI/EIN Number 20-1463895 Date Filed 08/06/2004 State Status ACTIVE Last Event CEL ADM DISS/REV Event Date Filed 11/10/2008 Event Effective Date NONE Principal Address 924 MCMULLEN BOOTH RD CLEARWATER, FL 33759 Mailing Address 924 MCMULLEN BOOTH RD „FL 33759 Registered Agent Name & Address 924 MC i -i �J /ATER FL 33759 Authorized Person(s) Detail Name & Address Title MR DABIRI, MASSOUD 924 MCMULLEN BOOTH RD CLEARWATER, FL 33759 Title MR DABIRI, MALOUSE 924 MCMULLEN BOOTH RD CLEARWATER, FL 33759 Annual Reports Report Year Filed Data 2015 01/10/2015 2016 03/08/2016 2017 01/12/2017 Document Images 0 M2f2M7—A%XWREP0RT Mew is �CiL�ff/1ZtIDt — RIt�lWti1 L cif mew sm ka SAF ftmraft CWTV-2f0T5--�- VIEW §MT7rt if 3 http://search.sunbiz.orp, l quiry/CorporationSearch/SearchResultDetail... J �( v®y GG G :-- C�CLEARWATER BRIGHT AND BEAUnFUL-BAYTO BEACH Planning & Development Department Petition for Annexation 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): Sandra A. Snelling MAILING ADDRESS: 3053 Grand View Avenue PHONE NUMBER: 727-797-6683 EMAIL: r���ii-T���{r� G cwt► -/`i 00 � �CJ� AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: Avg EMAIL: -- ADDRESS OF SUBJECT PROPERTY: 3053 Grand View �P o PARCEL NUMBER(S): 09-29-16-45126-001-0060 LEGAL DESCRIPTION: URRENT CITYSERVICES QUESTED CITY SERVICES; (select all that apply] KAPOK TERRACE SUB BLK A, LOT 6 SOLID WASTE/ SANITARY SEWER RECYCLING L, -WATER SOLID WASTE/ !/ SANITARY SEWER 1/ RECYCLING WATER Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 1 of 7 Revised 08.18.2016 �--�CLEARWATER BRIGHTMDBEAUnn%-BAYTo BEACH 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): RL REQUESTED (CITY): RL ZONING DISTRICT PRESENT (COUNTY): R-3 REQUESTED (CITY): Low Medium Density Residential (LMDR) SITE AREA: 0.20 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 0 (e.g., number of units, hotel rooms or non- residential square footage) acres USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; plus existing if to remain): If residential use, is unit(s), rental? Single family home N/A 0 RE 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 day of QGc9 0 (% by who is personally known/has produced as identification. Signature of property owner or reprg&entative Notary ublic, My commission expires: �—Y16K+d9-IfOMER@St Signature of property owner or representative �' Notary Public . State of Florida G 060626 i� "•'.;;,a� �.••' My Comm. Expires Mar 1, 2019 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 72 -562-4 6 ; Rp Page 2 of 7 Revised 08.18.2016 �1 CLEARWATER Planning & Development Department --� BlUG"T""°BE"""M" MYMBEACH 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://Ris.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; Page 3 of 7 Revised 08.18.2016 C%'`�CLEARWATER BRIGHT AND BEAUTIFUL- BAYTO BEACH 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; Page 4 of 7 Revised 08.18.2016 C-�'CLEARWATER BRIGHT AND BEAUTIFUL• BAY TO BEACH PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: Sandra A. Snelling 3053 Grand View Avenue 727-797-6683 Planning & Development Department Petition for Annexation PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPE NAME: INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY?,. CONTRACT IS: PARTIES INVOLVED — NAME: NAME: RE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY?i PARTIES INVOLVED — NAME: NAME: RE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? PARTIES INVOLVED — NAME: NAME: Disclosure Statement 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.-4� Sworn to and subscribed before me this /00 day of -- aresO ry . by S qr CR%CL dt so -ell/ who is personally known/has produced �F I L as identification. Signature of property owner or rep+ sentative ! 'Q, Notary public, i" My commission expires: , ;;:PY'P�a-,,VICKI JO KOMEROSKAS Signature of property owner or representative r: .° s Notary Public State of Florida Commission 0 GG 060826 , It .•• My -Comm. Expires Mar 4. 2019 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL Page 5 of 7 Revised 08.16.2016 C_17_�CLEARWATER Bivaw AND BEkunFM' BAY TO BEACH Planning & Development Department Petition for Annexation Affidavit to Authorize 1. Provide names of all property owners on deed —PRINT full names: nt/Representati` 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 3. That this property constitutes the property for which a request for (describe request): 4. That the undersigned (has/have) appointed and (does/do) appoint: as (his/their) agent(s) to execute any petitions or other documents n 5. That this affidavit has been executed to induce the City of Clearwa described property; �ary to affect such petition; Florida to consider and act on the above 6. That site visits to the property are necessary by City represen Ives in order to process this application and the owner authorizes City representatives to visit and photograp a property described in this application; 7. That (1/we), the undersigned authority, hereby certify th#14Ehe foregoing is true and correct. Property Owner Property Owner Property Owner Property Owner S E OF FLORIDA, COUNTY OF PINELLAS BEFORE ME THE UNDERSIGNED, 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 SAY AT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Public Signature Notary Seal/famp My Commission Expires: Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 6 of 7 Revised 08.18.2016 (7-��CLEARWATER `�'_ BRIGHT AND BEAUTIFUL- BAY TO BEACH PROPERTY OWNER (PER DEED): Sandra A. Snelling MAILING ADDRESS: 3053 Grand View Avenue CITY OF CLEARWATER CASE NUMBER: Planning & Development Department Petition for Annexation Supplemental Statement I/we, Sandra A. Snelling having filed a Petition for Annexation regarding the above property/case number, grant consent, agree and acknowledge that the City of Clearwater may immediately or at a later time process the application to completion, including adoption and recordation of related Ordinances, without the necessity to further notice me/us. This Supplemental Statement shall supersede any provision in any Agreement to Annex executed by me/us or my/our predecessors in interest. Select One Option Below Which Applies to This Petition for Annexation: ❑ Annexation of Contiguous Parcel(s): I/we further agree and acknowledge that I/we shall not rescind the Petition for Annexation or execute any documents attempting such rescission, and that any attempted rescission shall be of no force and effect. X❑ Annexation of Noncontiguous Parcel(s): I/we understand that this annexation is voluntary, and that I/we may withdraw this Petition for Annexation prior to final action on this Petition by the City of Clearwater. I/we further agree and acknowledge, however, that receipt of all sewer, solid waste or other city service is contingent upon completion of the Petition for Annexation process, and that any withdrawal of this Petition prior to final action by the City, may result in a discontinuance and termination of all City -provided services. STATE OF FLORIDA, COUNTY OF PINELLAS I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application. // Sworn to d subscribed before me this !S day of 4u, dbby /ISa_e_ . ,V2. who is personally known/has ("V1 _ e /lam. ��. , produced -PL ZL as identification. Sigrrature of propeftV owner (indiviMal or authorized representative of corporation, partnership or other entity) Notary pubqC__� My commission expires: Signature of co -property owner VICKI JO KOMEROSKAS Notary Pubk - State of Florida Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 7 of 7 Revised 08.18.2016 Planning & Development Department Petition for Annexation 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 Benjamin &Dara J. Jordan DEED): MAILING ADDRESS: 3058 Hoyt Avenue, Clearwater, FL 33759 PHONE NUMBER: 207-591-4443 EMAIL: Ll goy_ AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: 3058 Hoyt Avenue, Clearwater 33759 PARCEL NUMBER(S): 09-29-16-45144-009-0141 LEGAL DESCRIPTION: Lot 14, Block I, Kapok Terrace 1�1 Addition 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 Petition for Annexation Data Sheet PLEASE ENSURE THAT THE FOLLOWING INFORMATION IS FILLED OUT, IN ITS ENTIRETY. FAILURE TO COMPLETE THIS FORM WILL RESULT IN YOUR APPLICATION BEING FOUND INCOMPLETE AND POSSIBLY DEFERRED UNTIL THE FOLLOWING APPLICATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY): Residential Low (RL) REQUESTED (CITY): Residential Low (RL) ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): SITE AREA: 0.185 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residential square footage) R-4 One, Two and Three Family Residential Low Medium Densitv Residential (LMDR) acres USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; plus existing if to remain): f residential use, is unit(�)] ental?� Single Family Residential Single Family Residential Y1 p ❑ ❑ 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 tree and accurate to the best of rry knowledge and authorize City representatives to visit and photograph the property described in this applicgl* wa Sworn to and subscribed before me this 0V day of a0Q by r G� 361 4- —who is personally ` known /ha r produced �A 0 ( ct�C�� t/�CS Csu-Se as identification. Signature prape owner or representative '6 C(kCk- X-a&&C'u Signature of property o ner or representative Planning & Development Department, Page 2 of 7 public, emission expires: �d NOTARY PUBLIC ' Cwvyqt GGo57432 /*a*1A,90VArV9W,1FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Revised 02/16 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.pinellascountV.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 landuse 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 Information for Applicants ATTENDANCE AT PUBLIC HEARINGS The applicant or applicant's representative is encouraged to attend City Council public hearings unless the annexation pertains to a property developed or to be developed with one single family dwelling. STANDARDS FOR ANNEXATION In determining whether to annex a property, the City shall consider the extent to which: ❑ The proposed annexation will impact public services (e.g., water, sewer, police, parks, etc.). ❑ The proposed annexation is consistent with the City of Clearwater Comprehensive Plan. ❑ The proposed annexation requires a change in the future land use and zoning classifications assigned to the property as well as the jurisdiction for said change. ❑ Existing or proposed development is consistent with City regulations. ❑ Terms of a proposed Annexation Agreement, if any, promotes the City of Clearwater Comprehensive Plan. PROPERTY OWNER AGREEMENT Please be advised that, in consideration of the annexation, the property owners do hereby agree that: ❑ All structures and improvements which are erected upon said property subsequent to the date of this petition for annexation shall comply with all applicable City of Clearwater regulations and ordinances as set forth in the City Community Development Code; ❑ All residential rental units, including single-family residences must comply with the requirements in the city's residential rental ordinance, which requires the property owner to obtain a Business Tax Receipt upon annexation into the city; ❑ If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plat, and engineering plans shall be submitted to ensure compliance with the city's Community Development Code (see Submittal Package Instructions Checklist). It is recommended that the applicant meet with Planning and Development Department staff to review plans and/or discuss the applicable city regulations; ❑ All annexations of residential dwellings of eight dwelling units or more shall convey such recreation facilities fees and recreation land dedication and/or fees in the amount and manner prescribed by Chapter 54, Article 11 of Clearwater Code of Ordinances; and ❑ When any substandard abutting street or utilities are subsequently upgraded by the City to meet City Standards, said improvement(s) will be done on an assessment basis, consistent with City procedures therefore. 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 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 t and subscribed before me this c, day of 0-a . by �a.N.h "'A\-�G:- -%p 6_,, who is personally nown/has, � � ��� r prouced v, 10� C� cL �' u`S as identification. Signature or representative Signature of property owner or representative Planning & Development Department, 100 S. Page 5 of 7 No'tar'y public, Mygommission expires: Yolanda Darby. NOTARY PUUX IS STATE OF FLORMW WQT#fflk%4%Y, 1°M756, Tel: 727-562-4567; Fax: 727-562-4865 Expires 1113/2021A' Revised 02/16 Planning & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Benjamin & Dara J. Jordan MAILING ADDRESS: 3058 Hoyt Avenue, Clearwater, FL 33759 PHONE NUMBER: 207-591-4443 EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY': NAME: 4 4 ) INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? YES ✓NU CONTRACT IS: PARTIES INVOLVED - NAME: PHONE NUMBER: NAME: PHONE NUMBER: RE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY?, YES L,---N-O PARTIES INVOLVED - NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY MORLqA6j&QR LIENS ON THE SUBJECT PROP AYES NO ��p wJ`"ICYN PARTIES INVOLVED - NAME: 1cti •h PHONE NUMBER:a� j— 6944143 NAME: rA '-ToV-Ckctyl PHONE NUMBER: QC22- 5c?I - f14A 3 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 t and subscribed before me this c, day of 0-a . by �a.N.h "'A\-�G:- -%p 6_,, who is personally nown/has, � � ��� r prouced v, 10� C� cL �' u`S as identification. Signature or representative Signature of property owner or representative Planning & Development Department, 100 S. Page 5 of 7 No'tar'y public, Mygommission expires: Yolanda Darby. NOTARY PUUX IS STATE OF FLORMW WQT#fflk%4%Y, 1°M756, Tel: 727-562-4567; Fax: 727-562-4865 Expires 1113/2021A' Revised 02/16 Planning & Development Department Petition for Annexation Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed — PRINT full names: Benjamin Jordan Dara J. Jordan 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 3058 Hoyt Avenue, Clearwater, FL 33759 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 (1/we), the undersigned authority, hereby certify that the f9j:egoing is trueAd correct. Benjamin Jordan l Property Owner Property Owner Dara J. Jordan Property Owner Woperty Owner THIS STATE OF FLORIDA, COUNTY OF PINELLAS BEFORE ME THE UNDERSIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON 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 02/16 Planning & Development Department Petition for Annexation Supplemental Statement PROPERTY OWNER (PER DEED): Benjamin & Dara J. Jordan MAILING ADDRESS: 3058 Hoyt Avenue, Clearwater, FL 33759 CITY OF CLEARWATER CASE NUMBER: I/we, _Benjamin & Dara J. Jordan [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. 1/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 he best of my knowledge and authorize City representatives to visit and photograph the property described in this applicatipp. Sworn to and subscribed before me this pA Q` day of kk- by �` tNrho is personally knc�vn/has /` �, J� f �---� produced, D (i t S v^ r.kjas identification. SignatureViecfu perMoration, ner (individual or authorized represent partnership or other entity) public, Signature of co -property owner n expires: STATE OF FLORIDA Comm#gGG057432 Planning & Development Department, 100�'iiNfyrile�A41iT , Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 7 of 7 Revised 02/16 CLEARWATER BNGHTAW BEAUI7FUL•BAY70 BEACH I Planning & Development Department Petition for Annexation 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: TYPEOFANNEXATION. X CONTIGUOUS NONCONTIGUOUS (TYPE A ENCLAVE) To Be Completed By Property Owner: PROPERTY OWNER (PER DEED): Shirley A. Stewart MAILING ADDRESS: 3040 Merrill Avenue, Clearwater, FL 33759 PHONE NUMBER: 612-8357 nn EMAIL: �� ✓ a in A �YA lam' v 4 V100 . Cn AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: t _ EMAIL: ADDRESS OF SUBJECT PROPERTY: PARCEL NUMBER(S): LEGAL DESCRIPTION CURRENT CITY SERVICES: 3040 Merrill Avenue, Clearwater 33759 09-29-16-45126-001-0110 Lot 11, Block A, Kapok Terrace Subdivision REQUESTED CITY SERVICES: x (select all that apply) SOLID WASTE/ SANITARY SEWER RECYCLING x WATER SOLID WASTE/ SANITARY SEWER x RECYCLING 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 BRIGHT AND BfAtMRA- BAY TO BEACH 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: 0.198 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 1 acres USE OF PROPERTY: Existing (currently on site): Single Family Proposed (new use, if any; (e.g., number of units, hotel rooms or plus existing if to remain): Single Family non- residential square footage) If residential use, is unit(s) 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 applicati nt yl Sworn to and subscribed before me this 9l) day of —Aa, V F 90/-?- by (� SA 1-t' 1,0,f A- s fVva 0"t who is personally known/has produced f4e. DL'S as identification. Signature of pqperty owner or representative Nota%Oublic4=i;�,b._ NotaryPublic-StateofFlorida ' Commission # GG 088045 My commission expires: My Comm. Expires Mar 28, 1011 Signature of property owner or representative3 D �� ( " " Bonded through National 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 02/16 CLEARWATER BRIGHT AND BEAUI7FUL•BAY TD BEACH 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 Cl_�CLEARWATER� + � o BRIGHT MD BFAunFU -BAY TO BFACH ATTENDANCE AT PUBLIC HEARINGS Planning & Development Department Petition for Annexation Information for Apulicants 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. 0 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 81 Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 4 of 7 Revised 02/16 CLEARWATER BRIGHT AND BFAUnFUL• BAY TO BEACH PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: Planning & Development Department Petition for Annexation Shirley A. Stewart 3040 Merrill Avenue, Clearwater, FL 33759 612-8357 Disclosure Statement OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY?; CONTRACT IS: PARTIES INVOLVED — NAME: NAME: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY?� PARTIES INVOLVED — NAME: NAME: RE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? PARTIES INVOLVED — NAME: NAME: YES a% NO PHONE NUMBER: PHONE NUMBER: YES �,/ NO PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: STATE OF FLORIDA, COUNTY OF PINELLAS NO I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application t h Sworn to and subscribed before me this -2 d day of mav 9,0 f by S; r'l'Lo Y/ 7 VeW r_t , who is personally known/has produced /CL UL IS as identification. Signature of pro erty owner or representative MYRA JAMES _taFlorida Notary public, // /1� �/n/y « v` Commission#GGO 045 My commission expires: 3 / OFFt`�"' Bonded houghNatio als M % 8YAssn Signature of property owner or representative Planning & Development Department,100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-5624567; Fax: 727-562-4865 Page 6 of 7 Revised 02/16 C____�CLEARWATER Planning &Developmen/na ent BBICHTAND BEMMFUL-MY TO BEACH Petition for Anon Affidavit to Authorize Agent/Repreive 1. Provide names of all property owners on deed —PRINT full names: Shirley A. Stewart 2. That (I am/we are) the owner(s) and record title holder(s) of the following describe roperty: 3040 Merrill Avenue, Clearwater 33759 3. That this property constitutes the property for which a request for (describe - `quest): Annexation in order to receive solid waste and sanitary sewer service fro he City. 4. That the undersigned (has/have) appointed and (does/do) appoin as (his/their) agent(s) to execute any petitions or/Ctyof is necessary to affect such petition•, 5. That this affidavit has been executed to induce trwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by tives in order to process this application and the owner authorizes City representatives to visit ande property described in this application; 7. That (1/we), the undersigned authority, hereby ceregoing is true and correct. Shirlev A. Stewart THIS Property Owner Property Owner 'ATE OF FLORIDA, COUNTY OF PINELLAS Property Owner Property Owner BEFORE ME THE UNDERSIGNEDIfAN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON DAY OF PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND SAYSAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Sea Notary Public Signature My Commission Expires: Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-5624567; Fax: 727-562-4865 Page 6 of 7 Revised 02116 CLEARWATER BRIGHT MDBFAUTIFUL• BAYTO BFACH PROPERTY OWNER (PER DEED): Shirley A. Stewart Planning & Development Department Petition for Annexation Supplemental Statement MAILING ADDRESS: 3040 Merrill Avenue, Clearwater, FL 33759 CITY OF CLEARWATER CASE NUMBER: I/we, _Shirley A. Stewart [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: 19 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. ]/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. )7 Sworn to and subscribed before me this 3� day of I Q oZd/� by Sh l l� y S P j Vdt' , who is personally known/has . produced Fl- DYs— — - - 0. ' ration. Signature of propdrty owner (individual or authorized , ky1; " j a : Notary Public —State of Floridarepresentative of corporation, partnership or other commission4GG088045 entity) Q` My Comm: Expires Mar 28,2021 cop nalNotar AssnNotary ublic, My commission expires: Signature of co -property owner Planning & Development. Department,100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 7 of 7 Revised 02116 OFFICE of VITAL STATISTICS CERTIFIED COPY FLORIDA CERTIFICATE OF DEATH DCA' FILE NO. CEDENTS NAME (First, Middle, Last, Suflix) 2. SEX Michael David Stewart, Sr. Male 3, GATE OF BIRTH (Month, Day, Year) 4a AGE -last Birthday 46. UNDER 1 YEAR 4c. UNDER 1 DAY 5. DATE OF DEATH (Month. Day, Year) Mnnh� Days Hours --Minutes A$$pr11riCCSSlEECC 1 , 1 944 (Years) 61 April 17, 2005 6. OCURITY N� 7. BIRTHPLACE (Cityand State or Foreign Country) 8. COUNTY OF DEATH Vienna, West Virginia Pinellas 9. PLACE OF DEATH HOSPITAL: _Inpatient Emergency Roe"Outpatienl Dead on Arrival _ (Check only one) - NON -HOSPITAL: _ Hospice facility _ Nursing Home/Long Tenn Care Facility _X Decedam's Home _ Other (Specify) 10. FACILITY NAME (it 11, CITY, TOWN, OR LOCATION OF DEATH 1111. INSIDE CITY LIMITS? 3040 Merrill Avenue I Clearwater -x*4. 12. MARITAL STATUS (Specify) - _Yes 13. SURVIVING SPOUSE'S NAME (!(wile, give maiden name) _XManied _ Married, but Separaled Divorced - Never Married ShirleyFrederick _Widowed 14_ RESIDENCE -STATE 1411. COUNTY 14c. CITY, TOWN, OR LOCATION Florida Pinellas j Clearwater = STREET ADDRESS 14e. APT. NO.. 141. ZIP CODE 14g. INSIDE CITY LIMITS? 30.40 Merrill Avenue 33759 res 15a. CECEDENT'S USUAL OCCUPATION (Indicate type of wonr done during most of worinng life.) 1511. KIND OFBUSINESS/INDUSTRY Do not use 'Red -d' Color Technician Plastic Manufacturing 11 ,ECEDENTS RACE (Specify the -&-as to indicate what decedent considered Mmsell/hersel! fo be More than one race maybe speared.) X White _ Black or African American _ American Indian or Alaskan Native (Specly, tribe) - Asian Indian _ Chinese _ Filipino _Japanese _ Korean _V -1 -mese _ Other Asian (Spes,y) _ Native Hawaiian _ Guamanian or Chamorro _ Samoan _ Other Pacif [A. (Speay) _ Other (Specify) " DECEDENT OF HISPANIC OR HAITIAN ORIGIN? -Yes (H Yes, specify) X No Mexican Puerto Rican Cuban - CenvaLtSouth American _ - spsciy0 decedent was o! Hispanic or Haitian Origin.). - - _ Other Hispanic (Spa.W _ Haitian IS. DECEDENT'S EDUCATION (Specify the decedents highest degree or level of school completedat lime of death.) 19. WAS DECEDENT EVER IN U.S. ARMED FORCES? Bth or less _ Hlgh school but no diploma X High school dipbma or GED _ College but no degree College degree (Specify): _ Assodate _ Bachebrs _ Maslefs _ Doctorate _ Yes _X1,10 • 20. FATHER'S NAME (Firs( Middle, Last, Suffix) 21. MOTHER'S NAME (First, Middle, Maiden Surname) Ralph L. Stewart Emma Harrison 22a. INFORMANTS NAME 22b. RELATIONSHIP TO DECEDENT 23a. INFORMANTS MAILING - STATE Shirley Stewart Wife Florida 231,. CITY OR TOWN 23c STREET ADDRESS23d. 21P CODE Clearwater 3040 Merrill Avenue 33759 24, PLACE OF DISPOSITION (Name of cemetery, crematory, or othorplace) 25a. LOCATION - STATE 2511. LOCATION- CITY OR TOWN Palm Coast Mortuary Services 1 Florida Clearwater 26a. METHOD OF DISPOSITION _Burial _ Entombment _XCremation Donation _ R " val from Slat Ther (Speciy) 26b. IF CREMATION, DONATION OR BURIAL AT SEA, 27a. LICENSE NUMBER (olticenseej 711. S R 2E OF F RAL S ICE NSEE ORP SO ACTING A UC WAS MEDICAL EXAMINER APPROVAL GRANTED? X Yes No FE46Q1 2B. NAME OF FUNERAL FACILITY' FACILITY'S MAILING - t7rATf 12CIa. International Casket & Urn Gallery Funeral Home Florida 29:1CITY OR TOWN 11, STREET ADDRESS 29d, ZIP CODE Clearwater 2689 Sunset Point Rd 1 33759 p R -j I_RTIFIER: _ Certifying Physician - To the best of my knowledge, death occuned at the lime, date and place, and due to the causo(s) and manner stated.. :frock one) Medical Examiner - On the basis of examination, and/or investigation, in my opinion, death occuned at the time, data and place, due to Na cause(s) and manner stated. 'Signature and Title of Certiti )3111. DATE SIGNED (-Wdd/yyprj 32. TIME OF DEATH (24 hr.) 33: MEDICAL EXAMINER'S CASE NUMBER 6 04/18/2005 Found 1413 0 5 .0 fi. Q 0 5 2 1 4 54aLICENSE NUMBER (ot Certifier) 34b. C FIER'S NAME. 35. NAME OF ATTENDING PHYSICIAN (Mother Man Cadirer) i ME 80313 Susan Ignacio, M.D., M.E. 36a. CERTIFIER'S - STATE 36b. CITY OR TOWN 36c. STREET ADDRESS 361, ZIP CODE Florida Largo 10900 Ulmerton Rd. 33778 37, SUBREGISTRAR - Signature and Date 3Ba LOCAL R/E(GIISTRAR- Signature3811. DATE FILED BY EGISTRAR (Mo., Day, Yr.) Chief Deputy Registrar, Pinellas County Issued: April 22,200 THE ABOVE SIGNATURE CERTIFIES THAT THIS IS A TRUE AND CORRECT COPY OF THE OFFICIAL RECORD ON FILE IN THIS jOFFICE. I (s FTARI➢A D� EPA�11T� THIS DOCUMENT IS PRINTED OR PHOTOCOPIED ON SECURITY PAPER WITH A WATERMARK OF THE GREAT 7 ��r� 1 0 WARNING: SEAL OF THE STATE OF FLORIDA ON THE FRONT, AND THE BACK CONTAINS SPECIAL LINES WITH TEXT H p AND SEALS IN THERMOCHROMIC INK. I)!2 DOH FORM 1946 (02-04) 3AGES_.1._ ACCT RECcb DR219eAga DS—.--. INT FEES.... K11'F REV — fOTAL'3Q. !K GAL G AMT i -- 1 Wad $193 This Warranty Deed Made this 10th day of October A.D. 2000 by DANIEL BALL, an tmtarried man hereinafter called die grantor, to MICHAEL D. STEWART and SHIRLEY A. STEWART, husband and wife f 'i EEil F, ii kLRl4k, Ci.EF:% a 17-ili T; -'F If?', E,UTi,LCI&iIN c: CIC!_Fr•• whosest office address is: 3040 Merrill Av Clearwater, FL 33759 00-320047 OCT -20-2000 9:37put Grantees' Tax Id # :232-68-5235 � 6PINELLRS CO SK 11093 POh�(T -cIIl lOS 1 11Cre Cr lC C grdnlCC: �- (Wihencver used herein the lean 'graNur' and 'Manta' include all the parties to this instrument an un. heirs, legal rcpresenuaves and assigns of individuals, and the successors and assigns of wipontions) Witnesseth, that the grantor, for and in consideration of the sum of $ 10.00 and other valuable considerations. receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remiss, releases, conveys and confirms unto die grantee, all that certain land situate in Pinellas County, Florida, viz: Lot 11, Block A, RAPOR TERRACE, according to the Map or Plat thereof as recorded in Plat Book 36, Pages 14 and 15, Public Records of Pinellas County, Florida. SUBJECT TO covenants, restrictions, easements of record and taxes for the current year. Parcel Identification Number: 09-29-16-45126-001-0110 Togetherwith all the tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. To Have and to Hold, the same in fee simple forever. And the grantor hereby covenants with said grantee that the grantor is lawfullyseizcd of said land in fee simple: that the grantor has good right and lawful authority to sell and convey said land: that the grantor herby fully warrants the ride to said land and will defend the same against the lawful claims of all persons whomsoever, and that said land is free ofall encumbrances except taxes accruing subsequent to December 31, 99 In Witness Whereof, die said grantor has signed and sealed these presents the day and year first above written. Signed, sealed and delivered in our presence: ;lam �&4c I ELfJZABE H R GRISWOLD State of Florida County of Pinellas s!r/ � IEL BALL Tlhe foregoing instrument was acknowledged before me this 10th day of October DANIEL BALL, an umarried man who is persomilly known to me or who has produced vers license MY ELWBEi}Idn)tt9Wp(p 1 t &� ?5,D4 9296 tWvan,n otaryP hllc frim Na e: My commission aspires_ PREPARED BY: Beth Griswold RECORD & RETURN TO: Security First Title Partners 29261 U.S. Highway 19 North Clearwater, Florida 33761 File No: CL000524 2000, by as identification. p� Uy`tm _ C rA os r o,m r -ig o Zcoc YU b m.. Cr 53 x`03 ' ¢L,Q mV Q., Z - sm.mm Y`. o m OQM Q�'am ce) s o air= 5;, —001— Co yam' o: �t,��r F--- This Warranty Deed il=ex f� Uf"M,LKTN V. Made this loth day of October A.D. 2000 by DANIEL BALL, an 1—rried -An `Q1'1',;X'-('.' hereinafter called die grantor, to MICHAEL D. STEWART and SHIRLEY A. STEWART, husband and wife whose post office address is: 3040 Merrill Av ...... Clearwater, FL 33759 Grantees' Tax Id # :232-68-5235 00-320047 OCT-20-2000 9: 37M h c (lez V, ra n I cc.- PINELLRS Co SK 11093 FIG 1051 (Mmmver used kcivin the irm 'grantur' and 'gr3nim' include all the panics ics to this insdrument anu heirs, lcgal reprctentadva and naudgms or individuals, and the mocemn and amigns of wrpmidons) Witnesseth, dial the grantor, for and in consideration of the sum of $ 10.00 and other valuable considerations. receipt whereof is hereby acknowledged. hereby grants, bargains, sells, aliens, remises, rcleascs, conveys and confirms unto die Stantee, all that certain land situate in Pinellas County. Florida, viz: Lot 11, Block A, KAPOK TERRACE, according to the Map or Plat SAGES ACCT thereof as recorded in Plat Book 36, Pages 14 and 15, Public REC Records of Pinellas County, Florida. DR21 SUBJECT TO covenants, restrictions, easements of record and taxes for INT___ the current year. FEES.... MIT Pic jK BAL Parcel Identification Number: 09-29-16-45126-001-0110 AMT Togetherwithall the tenements, liereditaments and appurtenances thereto belonging or in anywise appertaining. To Have and to Hold, the same in fee simple forever. And the gramor hereby covenants with said grantee that the grantor is lawfiallyscized of said land in fee simple; that die grantor has good right and lawful authority to sell and convey said land, that the grantor hereby fully warrants the tide to said land and will defend the same against the lawful claims of all persons whomsoever, and that said land is free of all encumbrances except taxes accruing subsequent to December 31, 99 In Witness Whereof, die said grantor has signed and scaled these presents the day and year first above written. Signed, sealed and delivered in our presence: C el�4 IEL BALL ED Y#7jp [71-00AJAI I N— A AWww 1 ELIZAB+ L31GRISWOLD nzN— z L N— A AQ—: cli State of Florida County of Pinellas a) yfe <- C11 C OC The foregoing instrument was acknowledged before me this loth day of October 2000, by UJZ E W 0, Z cow y - cc 75 DANIEL BALL, an umarried man < who is persomilly known to me or who has produced as identification 113. z W vers license uO'S E KMilli- - . 6 -to i UY=M LU I-- DSnES:OftV =949M < Paint Na 'lnac 0 1114— In Koury MY Commission Npim-� PREPARED BY: Beth Griswold RECORD & RETURN TO: j, Security First Title Partners WD-13 29261 U.S. Highway 3.9 North 519 Clearwater, Florida 33761 File No: CL000524 4K CLEARWATER j BRIGHT AND BLAUMUL• BAY TO BrACH Planning & Development Department Petition for Annexation 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: $0 IMPACT FEE/ASSESSMENT FEE: TBD Information on Impact Fees or Assessment Fees is available from the City of Clearwater Engineering Department (562-4747). To Be Completed By City of Clearwater: TYPE OF ANNEXATION:... X CONTIGUOUS NONCONTIGUOUS (TYPE A ENCLAVE) To Be Completed By Property Owner: PROPERTY OWNER (PER DEED): LELETHE FRITH-CARNABUCCI MAILING ADDRESS: 30.79-MERRILL—AVE-t3LEARVhkT£R-FL 33759=3450 PHONE NUMBER: 568-648-4528 EMAIL: Ifrithcarabucci@verizon.net thA,Ilrn l4>^ �n�o �I AGENT OR REPRESENTATIVE: ) % 2 u v MAILING ADDRESS: _ PHONE NUMBER: -7-7 EMAIL: I rill ADDRESS OF SUBJECT 3077 Merrill Ave PROPERTY: PARCEL NUMBER(S): 09-29-16-45144-009-0020 LEGAL DESCRIPTION: KAPOK TERRACE 1ST ADD BLK I, LOT 2 URRENTCITYSERVICF.S: SANITARY SEWER EQUESTED CITYSERVIC0 SANITARY SEWER select all that apply); SOLID WASTE/ \� RECYCLING WATER / SOLID WASTE/ ' / V RECYCLING V WATER Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 1 of 7 Revised 08.18.2016 „ C-: IL 4XW MK.:$t1 Et_R•VM.. 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-4 REQUESTED (CITY): Low Medium Density Residential (LMDR) SITE AREA: 0.19 SIZE OF DEVELOPMENT:; Existing: 1 Proposed: 0 (e.g., number of units, hotel rooms or non- residential square footage) acres USE OF PROPERTY: Existing (currently on. site): Single Family Dwelling roposed (new use, if any) lus existing if to remain)l 4,1�� �f residential use, is unit(s) rental?i'tu' RE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY:? YES ❑ NO ill IF YES, PLEASE LIST/EXPLAIN: STATE OF RIDA, 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 applica^tion. Sworn to and subscribed before me this �S-1 4, day of --� by 9f Jf . j� who is personallyr�iisll L� L,c e_ ' l^ I I�'l — II b L t�l%�.l'tn.�.s��eU produced�� ���•�� i^V1.� ��•aSignature of property owner 9T representative F-[— . W,V Q.Y' (iC.GA (� I �h u Com, Signature of property ot6er or representative M Planning & Development Page 2 of 7 Notary public, My commission expires: SAUSAN TOHMAZ Notary Public, State o Texa,, +P Comm. Expires 06-01-2020 ilyrtle AVetarg, ICIebM`aWFB. 3; Tel: 727-562-4567; Revised 08. rl-��)CLEARWATER BRIGHT AND BEAtMRX• BAYTO RFACH 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 Ris/. ❑ 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; Page 3 of 7 Revised 08.18.2016 CLEARWATER BRIGHT AND BEAtMn;I.-RAY TO BEACH 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; Page 4 of 7 Revised 08.18.2016 (7CLEARWATER \'� ■ I RRtGW MM REAIMRA.-RAY TO REACH PROPERTY OWNER (PER DEED): LELETHE FRITH-CARNABUCCI Planning & Development Department Petition for Annexation Disclosure Statement MAILING ADDRESS: 307-7-MERRILL AVE CLEARW FL 33759-34-50 PHONE NUMBER: 508-648-4528 ruJ fA&(1Uw P,4ke-V.; j0q )-2 #G(e6nZ1 eat A EMAIL: Ifrithcarabucci@verizon.net S ciK 7Y L .B'2c{v 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 NO CONTRACT IS: PARTIES INVOLVED - NAME: PHONE NUMBER: NAME: PHONE NUMBER: RE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? YES NO PARTIES INVOLVED- NAME: PHONE NUMBER: NAME: RE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY., PARTIES INVOLVED - NAME: 5de� Lt, S NAME: 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 day of d01 ? by LG e- CAXAO-6 who is personally known/has pev K ..(Yc produced _ 1:716r�c� Qr ue.g,- as identification. of prop jAy owder or representative Notary pLffilic, W o commission expires: a"a ' lc,— ae-2DO My 3 m Signature of property owner or representative X N � CO o m N Z �o Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562.4567; p O o N Page 5 of 7 Revised 08.18.2016 CLEARVVATER Planning & Development Department BRIGHT AND BEAVCIFUL•BAY TD REACH Petition for Annexation Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed — PRINT full names: 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 3. That this property constjtutes the property for which a request for (describe request): 4. That the undersigned (has/have) appointed and (does/do) appoint: as (his/their) agent(s) to execute any petitions or ot/en nec Baryto affect such petition; 5. That this affidavit has been executed to induce the a , Florida to consider and act on the above described property; 6. That site visits to the property are necessary by Cityes in order to process this application and the owner authorizes City representatives to visit and phroperty described in this application; 7. That (1/we), the undersigned authority, hereby certifgoing is true and correct. Property Owner Property Owner BEFORE ME THE UNDERSIGNED, THIS DAY OF DEPOSED AND SAYS Property Owner Property Owner OF FLORIDA, COUNTY OF PINELLAS 'DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN T HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Public Signature Notary Seal/Styhp My Commission Expires: Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 6 of 7 Revised 08.18.2016 CLEARWATER MUrIff AND BVAUT6 X- BAY TO MACH PROPERTY OWNER (PER DEED): LELETHE FRITH-CARNABUCCI Planning & Development Department Petition for Annexation Supplemental Statement MAILING ADDRESS: 3�W7 MERFM-t AVE CLEARWATER-FL-3-3-YA-3450 yj.J WCjIb"IJ gted4e--4 �oc� 22 (d a ne. A CITY OF CLEARWATER CASE NUMBER: o) -rX 7.72 q o 1/we, LELETHE FRITH_ ABUCCI, having filed a Petition for Annexation regarding the above property/case number, grant consent, agrel3rid 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 [/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 `7 day of by L.C4t Ae— 64A -tiGl� ho is personally known/has <ik ,Z � C -_.S Signature of propeVdwnbr (individual or authorized representative of corporation, partnership or other entity) Signature of co -property owner produced P6,o - JC._. "�,r « U & as identification �Q T o n Notary public, o My commission expires: l a a ate% Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 7 of 7 Revised 08.18.2016 Planning &.Development Department Petition for Annexation 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 WIT.WIN 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 (562-4'747). 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): John W. Yantorno, Jr: MAILING ADDRESS: PO Box 8002, Woodland Park, CO 80863 PHONE NUMBER:. 719-721-0768 EMAIL: AGENT OR REPRESENTATIVE: LEGAL DESCRIPTION: dot 56, Del Oro Gardens — CURRENT CITY. SERVICES: SANITARY SEWER SOLIDWASTE/ x WATER' REQUESTED CITY SERVICES: SOLID WASTE/ x SANITARY SEINER 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 T Revised 02A6 11 L.q H.\l.; 0,tt.\t,... 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. Urban (RU). REQUESTED (CITY.).; Residential Urban (RU) ZONING DISTRICT PRESENT (COUNTY); R-3 Single Family Residential REQUESTED (CITY): Low Medium Density Residential (LMDR) SITE AREA: 0.213 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 1. (e.g., .number of units, hotel rooms or non- residential squore footage) acres USE OF PROPERTY: Existing.(currently onsite):. Single Family Residential Proposed (new use, if any; Plus .existing if to remain): Single Family Residential If residential use, is unit(s) rental? ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE'PROPERTY' WITHIN PINELLAS COUNTY? YES ❑ NO IF YES, PLEASE LIST/EXPLAIN: Ar�Ylllil RITE, --- STATr eierrrnir 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- Sworntoand subscribers before me this day of by s111r4 11l 1s 1 tilYt 7%�!�' rJl :who is personalty known6as produced (lr �•,;. 1 �,,, `E as identification. Si ature of pro rty can*orpreti e — Signature of property owner or representative Notary public;. My commission expires:,1% Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562 4567; Fax: 727-562 865 Page 2 of 7 Revised 02116 Planning & Development Department nX 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 theert ro p. p y is nota 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 beinitiated 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.Pldn, the applicant will be required to file a companion application toamend the map. ❑ Proof of ownership (e.g., copy of deed, title insurance policy, or other instrument demonstrating ownership). El 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),: 0 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`cp Appraiser's Office website at www.oao.org (.search database by address). U 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.ocpao.ork_ U 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://Pis.pinehascounty or /public gis/. Search by property address or Parcel I.D. Number and report will appear. O FUTURE LAND USE PLAN DESIGNATIONCITY ( ) 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). Ll ZONING DISTRICT (COUNTY) can be found by viewing a Property :Report using Pinellas County's Public GIS Viewer available online at http://Qis:pinellascountV oegZpublic gist. C7 ZONING DISTRICT (CITY) can be found b.y contacting the Planning and Development Department or viewing the City's Zoning Atlas, available online at ektgis-mycle,arWater.com/Zoning- El SITE AREA (ACRES) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at ht (as 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 A1 W 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 pertainsto 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.). El The proposed annexation is consistent with the City of Clearwater Comprehensive Plan. O 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. 0 Existing or proposed development is consistent with City regulations. 0 Terms of;a proposed. Annexation Agreement; if any, promotes the City of Clea`rwater,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 areerected 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 farriily 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,staffto 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 improvements) will be done on an assessment basis, consistent with City procedures therefore, Planning & Development Department, 100S. Myrtle Avenue; Clearwater, FL 33756, Tel: 727-562.4567; Fax: 727-562-4865 Page 4 of 7 Revised -02!16 WW:i; I IM: KLAI: 111T!• Kk) ty: jui.c" PROPERTY OWNER (PER DEED): John W. Yantorno, Jr Planning & Development Department Petition for Annexation Disclosure Statement OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: INTEREST IS: SPECIFIC INTEREST HELD: ,DOES. A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? YES. NO CONTRACT IS: PARTIES INVOLVED —NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY OPTIONS To PURCHASE THE SUBJECT PROPERTY? YES NO PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? YES, NO PARTIES INVOLVED = NAME: PHONE NAME: r PHONE MBEFW*RIS.HITE NOTARY -ft OF COL STATE OF FLORIDA, COUNTY OF PINELLAS P" 1.(we), the undersigned, acknowledge that all representations made in this application Pre true and accurate to. the best of my ,knowledge,and authorize City representatives to visit.and photograph the property described in this applicatio I n- Sworn..t.o:and subscribed before me this �2 —day of _ac/ by who is personally known(has p9roduced' produced I as identification, nature f ropert owner or 4repr se: tative 01 Si natu of Notary. public, MY commission expires: _S7ignatureof property owner or reorpsontativp Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4561; Fax: 727 Page 5 of 7 -5624865 Revised 02116 r N+a i+r Ali 0{T l 7..i • U•r t, PIanning & Development Department Petition for Annexation Affidavit to Authorize Agent, Representative 1. Provide names of all property owners on deed PRINT full .names, John W. Yantorno; Jr. 2. That (l am/we are) the owner(s) and record title holder(s) of the following described property: 3136'San. lose Street, Clearwater, FL 33759 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 an such p y petitions or other documents:necessary to affect such petition; 5. That this affidavit has been executedto induce the City:of Clearwater, Florida to consider and.act on the above: described property; r-1 That site visits to the property are necessary by City representatives in order to process this application and the owner author'Izes City representatives to visit and photograph the property described in this nnnlirari.,..- 7. That (1/we.), the undersigned authority, hereby certify th John W.'Yantorno, Jr. 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 �Ci�;• DAY OF � GLv� n9lPERSONALLY APPEARED 1 Notary WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND. SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHESIGNED. SWIMS. HITESNEyy NOTARY PUBLIC STATE OF COLORADO Notary Public. Signature MY Commission Expires: C'-% Planning 8 Development De Page 6 of 7 partment, 100 S: Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax:. 121-562-4965 Revised 02/16 Planning & Development Department �;C�M,r Ilphl'r rtrnt nTr'f Sl rv_li:dn Petition for Annexation Supplemental Statement PROPERTY OWNER (PER DEED): John W. Yantorno, Jr. MAILING ADDRESS: PO Box 8002, Woodland Park, CO 80863 CITY OF CLEARWATER CASE NUMBER:. I/we, John W. Yantorno, Jr. [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 ,latertime 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 //�� ice_ r1 nr • who is personally known,�iias produced l��n(—' "l&,.\�-ivk('� .:C ��,iti ' � as identification_ Sig atu of prop owne (individual or auth ri ed re Partnership or Signature of co -property owner Notary Public, My commission expires: (,(� 1 STATE OF NOTARY ID MY Connnission Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-5624567; Fax: 727-562 4865 Page 7 of 7 Revised 02116 _. CLEARWATER 6WCHT NID BEAUTTNL• BAY71D BFACFi Planning & Development Department Petition for Annexation 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): Dabiri, Massoud Mike NONCONTIGUOUS (TYPE A ENCLAVE) MAILING ADDRESS: C/O Savoy LLC 924 N. McMullen Booth Rd Clearwater FL 33759 PHONE NUMBER: 727-726-8787 EMAIL: RUGBAZAAR@AOL.COM Qr AGENT OR REPRESENTATIVE: � js%k� MAILING ADDRESS: -�f�i�9f�/�y!'/�iP� ,/��� ,% • ,,� �' T� PHONE NUMBER: z-,2% EMAIL: ,� G ADDRESS OF SUBJECT 3080 Terrace View PROPERTY: PARCEL NUMBER(S): 09-29-16-45126-003-0020 LEGAL DESCRIPTION: KAPOK TERRACE SUB BLK C, W 57.6FT OF LOT 2 URRENT CITY SER V*� SANITARY SEWER EQUESTEDCITY SER VICES: SANITARY SEWER (select all that apply) SOLID WASTE/ RECYCLING / SOLID WASTE/ RECYCLING WATER WATER Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-662-4567; Page 1 of 7 Revised 08.18.2016 �CLEARWATER ARIGHT AD1D BEAUT6'UL • BAY TO BFACH 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): RL REQUESTED (CITY): RL ZONING DISTRICT PRESENT (COUNTY): R-3 REQUESTED (CITY): Low Medium Density Residential (LMDR) SITE AREA: 0.16 acres SIZE OF DEVELOPMENT: Existing: 1 Proposed: 0 (e.g., number of units, hotel rooms or non- residential square footage) USE OF PROPERTY: Existing (currently on site): Single Family House Proposed (new use, if any; plus existing if to remain): rresidential use, is units) ental? N/A RE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? YES ❑ N010/ F 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 is day of by "&sLo,.Gi (-)o-bi r-. , 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 MY COMMISSION # GG EXPIRES: August 14, Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 2 of 7 Revised 08.18.2016 C)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 eis/. ❑ ZONING DISTRICT (CITY) can be found by contacting the Planning and Development Department or viewing the City's Zoning Atlas, available online atextgis.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: 727.662.4567; Page 3 of 7 Revised 08.18.2016 CLEARWATER tH11CHTAA'D BLAlT!]iUl.•BAYTOBIACH 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 toning 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; Page 4 of 7 Revised 08.18.2016 CLEARWATER Planning & Development Department """'M" JA"'° WMPetition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Dabiri, Massoud Mike MAILING ADDRESS: C/O Savoy LLC 924 N. McMullen Booth Rd Clearwater FL 337S9 PHONE NUMBER: 727-726-8787 EMAIL: RUGBAZAAR@AOL.COM AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: bTHER 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: RE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? YES r/ NO PARTIES INVOLVED— NAME: PHONE NUMBER: NAME: PHONE NUMBER: RE 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 1 day of 1 1 cT" el ?C 1-1 by H as S ovvc{l7. "t r , who is personally known/has ,l produced PC Drivc.ri LiCense— as identification. Signature of property owner or representative Notary public, ' My commission expires: g (I 4 Signature of property owner or representative TANIA my rommissioN G 020844 EXPIRES: August 14, 2020 Bonded Thru Notary Pub Underwrltene Planning & Development Department,100 S. Myrtle Avenue, Clearwater, Fl- 33756, Tel: 727-562-4567; Page 5 of 7 Revised 08.18.2016 K; 'EN M Planning & Development Depa nt Petition for Annex ion Affidavit to Authorize Agent/Represe five 1. Provide names of all property owners on deed —PRINT full names: 2. That (I am/we are) the owner(s) and record title holder(s) of the following described praerty: 3. That this property constitutes the property for which a request for (describe regAt): 4. That the undersigned (has/have) appointed and (does/do) appoint: as (his/their) agent(s) to execute any petitions or/of necessary to affect such petition; 5. That this affidavit has been executed to induce trwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by tives in order to process this application and the owner authorizes City representatives to visit ande property described in this application; 7. That (1/we), the undersigned authority, hereby ceregoing is true and correct. THIS Property Owner Property Owner ATE OF FLORIDA, COUNTY OF PINELLAS Property Owner Property Owner BEFORE ME THE UNDERSIGN AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON DEPOSED AND Notary Sealffamp DAYg PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN T HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Public Signature My Commission Expires: Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-5624567; Page 6 of 7 Revised 08.18.2016 CLEARWATER BRIGM AND BEAumm- BAYTO BEACH PROPERTY OWNER (PER DEED): Dabiri, Massoud Mike Planning & Development Department Petition for Annexation Supplemental Statement MAILING ADDRESS: C/O Savoy LLC 924 N. McMullen Booth Rd Clearwater FL 33759 CITY OF CLEARWATER CASE NUMBER: I/we, Dabiri, Massoud Mike 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 )si- day of 7ir-r� t LO I'7 by /��►" �issov.c( Dob�r-► who is personally known/has produced FL t>-►ve. ,S L,(cense- as identification. Signature of property owner` individuafor authoriz, representative of corporation, partnership or other entity) Notary public, My commission Signature of co -property owner •�i?tim�• - TANIAVASQUEZ 'Q 1% MY COMMISSION # GG 20844 ":. :;• EXPIRES: August 14, 2020 Bonded TMu Notary Publk U Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 7 of 7 Revised 08.18.2016 CLEARWATER swcrrrn nsenuneuL•nnvrosencH Planning & Development Department Petition for Annexation 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: TYPEOFANNEXATION: X CONTIGUOUS NONCONTIGUOUS (TYPE A ENCLAVE) To Be Completed By Property Owner: PROPERTY OWNER (PER DEED): Ralph M Przybeck MAILING ADDRESS: 3127 Wolfe Road PHONE NUMBER: 430-1392 EMAIL: gayleprzy777@hotmail.com r� - P AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: 3127 Woffe Road PARCEL NUMBER(S): 09-29-16-05310-000-0080 LEGAL DESCRIPTION: BAYVIEW BLUFF LOTS H AND I CURRE/VTCITYSERVKFS:, SANITARY SEWER EQUESTEDCITY SER VICES:,_ SANITARY SEWER (select all that apply) SOLID WASTE/ RECYCLING WATER SOLID WASTE/ RECYCLING WATER Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tei: 727-562-4667; Page 1 of 7 Revised 08.18.2016 CLEARWATER BRICITI AND BEAUfl1'IB. • BAY TO BEACH 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): RU REQUESTED (CITY): RU ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): SITE AREA: 0.45 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 0 (e.g., number of units, hotel rooms or non- residential square footage) R-3 Low Medium Density Residential (LMDR) acres USE OF PROPERTY: Existing (currently on site); Proposed (new use, if any; plus existing if to remain): �If residential use, is unit(s). reg_ ntal?� Single Family House N/A ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? YES ❑ N0lj� 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 4 day of 02� by Q who is personally known/has produced fZ �� as identification. Signature of property owner or represen tive •"/. ERIKA R. MEDIA ;riA�1 DIY' NAI' gflNAMISSION # rr, 30Y8g i ry pu 1c, ------------- 3 e � EXPIRES: November 2020 M - Y commission expires: Signature of property ow Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 2 of 7 Revised 08.18.2016 CLE A RWWATERPlanning & Development Department B«,�M,�B���, ,rU4.DAY1n�„F' 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 ANDJOR 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://jzis.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 htto: //ais.pinellascounty ore/public eis/. ❑ 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 or /public gis/. Page 3 of 7 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Revised 08.18.2016 C.�__)CLEARWATER BRIGHT AVD BEAUTIFUL' BAY TU BEACH Planning & Development Department Petition for Annexation Information for Applicants ATTENDANCE AT PUBLIC HEARINGS 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, Tei: 727-562-4567; Page 4 of T Revised 08.18.2016 V BRIGHT W) BEAUnFUL•BAYTO HEACH Planning & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Ralph M Przybeck MAILING ADDRESS: 3127 Wolfe Road PHONE NUMBER: 430-1392 EMAIL: gayleprzy777@hotmail.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: ' D PHONE NUMBER: EMAIL: THER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: INTEREST IS: jV0 SPECIFIC INTEREST HELD: ES 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?; PARTIES INVOLVED — NAME: NAME: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY?1 PARTIES INVOLVED — NAME: NAME: YES PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: STATE OF FLORIDA, COUNTY OF PINELLAS NO 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 day of 2017 by r �C who is personally known/has produced as identification. >1g6We of property owner presentativ Signature of property ERIKA R. MEJIA otary public, MY COMMISSION # OG 30289 E)IPIRES: November 25. 2020 ly commission expires: II1ZS120 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tei: 727-562-4567; Page 5 of 7 Revised 08.18.2016 CLEARWATER Planning & Development Depart nt �` I1RI6Frf.iW1)IfEAU'77FUL•71AY TO BEACH P \'raw Petition for Annex ion Affidavit to Authorize Agent/Represe five 1. Provide names of all property owners on deed —PRINT full names: 2. That (I am/we are) the owner(s) and record title holder(s) of the following described perty: 3. That this property constitutes the property for which a request for (describer uest): 4. That the undersigned (has/have) appointed and (does/do) appoin as (his/their) agent(s) to execute any petitions or other doc encs necessary to affect such petition; 5. That this affidavit has been executed to induce the City Clearwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by Ci representatives in order to process this application and the owner authorizes City representatives to visit an hotograph the property described in this application; 7. That (1/we), the undersigned authority, here certify that the foregoing is true and correct. Property Owner Property Owner Property Ow Property Owner STATE OF FLORIDA, COUNTY OF PINELLAS BEFORE ME THE U ERSIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON THIS DAY OF PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN DEPO AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OFTHE AFFIDAVITTHAT HE/SHE SIGNED. Seal/Stamp Notary Public Signature My Commission Expires: Page 6 of 7 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-5624567; Revised 08.18.2016 '�1CLEARWATER BRICIi'f' ANq BGUTiI'UL •BAY 7U BBACH PROPERTY OWNER (PER DEED): Ralph M Przybeck MAILING ADDRESS: 3127 Wolfe Road CITY OF CLEARWATER CASE NUMBER: Planning & Development Department Petition for Annexation Supplemental Statement I/we, Ralph M Przybeck , 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: XD Annexation of Contiguous Parcel(s): I/we further agree and acknowledge that I/we shall not rescind the Petition for Annexation or execute any documents attempting such rescission, and that any attempted rescission shall be of no force and effect. O Annexation of Noncontiguous Parcel(s): I/we understand that this annexation is voluntary, and that 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. p Sworn to and subscribed before me this /J day of MOV 20/7 by C� who is personally known/has P roduced ` as identification. Signature of property bwner (indiviclGal or representative of corporation, partnership entity) Signature of co -p ERIKA R. MEJA MY COMMISSION # r..G 30289 Bor4ed7hoil,", 'Navy Ann. Notary public, My commission expires: Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tei: 727-562-4567; Page 7 of 7 Revised 08.18.2016 property into the City pursuant to Section 171.044, Florida ;Statutes, and the Interlocal Service Boundary Agreement authorized by Section 171.204, Florida Statutes, and the City has complied with all applicable requirements of>Florida law in connection with this ordinance; now, therefore, BE 1T ORDAINED BY THE CITY COUNCIL .OF THE CITY OF CLEARWATER, FLORIDA: Section 1. The following -described properties are hereby annexed into the City of Clearwater and the boundary lines of the City are redefined accordingly: See attached Exhibit A for: legal Descriptions (ANX2017-06013 The map wattached as Exhibit B is hereby incorporated by reference. Section 2. The provisions of this ordinance are found and.determined to be consistent with the City of Clearwater Comprehensive Plan. The City Council hereby accepts the dedication of all easements, parrs, rights-of-way and Other dedications: to the public, which have -heretofore been. made by plat, deed or user within the annexed property. The Cdy'Engiineer,_the City. Clerk and the Planning and Development Director are directed to include and show the property described herein upon the official maps and records of the City: Section 3. This ordinance shall take effect immediately upon; adoption: The Cita Clerk shall file certified copies of this ordinance, including the map attached hereto, with the Clerk of the Circuit Court and with the County Administrator of Pinellas County, Florida, within 7 days after adoption, and shall file a certified copy with the Florida Department of State within 30 days after adoption. KEN BURKE, CLERK OF COURT AND COMPTROLLER PINELLAS COUNTY, FL INST# 201735684111122/2017 09:25 AM OFF REC BK: 19850 PG: 871-874 DocType:GOV RECORDING: $35.50 Ordinance No. 905$-17 Legal Descriptions ANX2017-06013 Exhibit A Address LegalDescriptipn Into. Parcel Id SCS Glen Oak Lot 6, Block C, KAPOK TERRACE, according to the platthereof as Ave E. recorded in Plat Book 36, Pages 14 and 15, Public Records of Pinellas 09-29-16-45126-003-17060 County, Florida. 907 Glen Oak Lot 9, Block C, KAPOK TERRACE, according to the map or plat: thereof, Ave:E. as recorded in Plat Book 36, Page(s) 14 and 15,of the Public Records C19-29-16-45126-003-0090 _ of Pinellas County,Florida. 915 Glen Oak Lot 11, Block C, KAPOK TERRACE, a subdivision according to the plat Ave E. thereof recorded at Plat Book; Pagem in .the Public Records of Pinellas 09-29-16-45126-003-0110 County, Florida. 3Q53 Grand Lot 6, Block "A", KAPOK TERRACE, according to the:map or plat 053 Ave.. thereof as recorded in Plat Book 36, pages 14'and 15, Public Records 09-29-16-45126-001-0460 of Pinellas County, Florida. Lot 14, Block 1, KAPOK TERRACE FIRST ADDITION, according to the 3058 Hoyt Ave. map or plat thereof, as recorded in Plat;Book.49; Page 48 of the Public 09-29-16-05144-009-0140 Records of Pinellas County, Florida. Lot 11, Block A, KAPOK TERRACE; according to the Map or Plat thereof. 3040 Merrill as recorded in Plat Book 36, Pages 15 and 15, Public Records of Ave Pinellas County, Florida A/KJA/ 3040 Merrill Avenue, Clearwater, FL X2916 45226 C1014110 33759 3077 Merrill Lot 2, Block 1, KAPOK TERRACE FIRST ADDITION.; according to the map Ave. or plat thereof, as recorded in Plat Book 49, Page 48, of the Public 09-29-16-45244-009-0020 Records of Pinellas County, Florida. 3136 San lose Lot 56, DEL ORO GARDENS, according to the map or plat thereof as St. recorded in Plat Book 45, Page 74, Public Records of Pinellas County, 09-29-16-20808-000-0560 Florida. Lot 2, Block C, KAPOK TERRACE, according to the Plat thereof, as 3080 Terrace recorded in Plat Book 36, Pages 14 and 15, Public Records of Pinellas Yew Ln. County recorded in the office records book 6156, page 1275, of the 09-29-16-45126-003-0020 public records of Pinellas County, Florida. 3127 Wolfe Rd. -Bay View Bluff Lots H and 1 09-29-16-05310-000.0080 70 1, :11 1 - t A• s" d7 1 it. ••1, • .A..' gg <. n . Se GRAMO VIEWAVE « . SAN MATEO ST " MERRlLL AVE e . THOMAS RD 9 may.".yr * ;: •eif '.. ' r t st` ♦ • .� .� !X 3r "I L i �N M iU • K 1 !' 1 e 7 e MERRlLL AVE e . THOMAS RD 9 may.".yr * ;: •eif '.. ' r t st` ♦ • .� .� !X 3r "I L i �N M iU • K 1 !' . A., a �. �a t � p ^ • 3 • WOLFE.RD p Q e HOYT AVE 72.90 A.!. "W .n t.a Acis t `ei IT, o w ,. IF" s 1 •aF a :a•• s 'i�. .. - . RRtPiSED ANNEXATION Multiple Owners; See Attached Sheet Case: ANX2017-fl6fl] 3 Property Site: Multiple Addresses, See Attached Acres Size ( ) 2.]32 ROW (Acres): Land Use Zoning Multiple PINS. See . PIN: Attached Sheet - From !..: RL I RU R-3 Atlas Page: 283A TO: RL/RU LMDR Exhibit B Ordinance No. 8059-17 PASSED ON FIRST READING PASSED ON SECOND AND FINAL READING AND ADOPTED uarnflo A. 50t0 Assistant City Attorney AUG .1..6 2017 NOV 1 .1 2017 George N. Cretekos Mayor .Attest: Rosemarie Cali City :Clerk Ordinance No. 9059-17 Legal Descriptions ANX2017-06413 Exhibit A Addrm t.egal Description;: No. Parcel Id Oak Lot 6, Block C, KAPOK TERRACE, according to the plat thereof;as . e E. AveAv recorded in .Plat Book 36, Pages 14 and 15, Public Records of Pinellas 09-29-16-45226-003-0060 County, Florida. 907 Glen Oak Lot 9; Block C, KAPOK TERRACE, according to the map, or plat thereof, Ave'E: as recorded in Plat Book 36, Pages) 14 and 15, of the Public Records 09-29-16-45126-003-0090 of Pinellas County, Florida.' 915 Glen Oak Lot 11, Block C, KAPOK TERRACE, a subdivision according to the plat Ave E. thereof recorded at Plat Book, Pagem in the Public Records.of Pinellas 09-29-1645126-003-0110 County, Florida. 3053 brand ;: Lot 6, Block "A", KAPOK TERRACE,, according to the map or plat View Ave. thereof as corded in Plat Book 36, pages 14 and 15;Public Records 09-29=16-45126-001-0060 of Pinellas County, Florida. Lot 14, Block i, KAPOK TERRACE FIRST ADDITION, according to the 3058 Hoyt Ave. map or.plat thereof; as. recorded in Plat Book 49, Page 48 of the Public 09-29-16-45344-00 -0140 Records of Pinellas County, Florida. Lot.11, Block A, KAPOK TERRACE; :according to the. Map or Plat thereof :.3040 Merrill as recorded in Plat Book 36, Pages 15 and 15, Public Records of Ave Pinellas County, Florida A/K/A/ 3040 Merrill Avenue; Clearwater, FL 09-29-16-45126-001-0110 33159 3077 Merrill Lot 2Block 1, KAPOK TERRACE FIRST ADDITION, according to the map.. Ave. ... or -plat thereof, as recorded in Plat Book 49; Page 48, of the Public 09-2946.45144-0d9-0020 Records of Pinellas County, Florida. . 3136 San Jose Lot 56, DELORO GARDENS, according to the map or plat thereof as St. recorded in Plat Book 45, Page 74, ;Public Records of Pinellas County; 09-29-16-20808-000-0560 Florida. Lot 2, Block C, KAPOK TERRACE, according to the Plat thereof, as 3080 Terrace recorded in Plat Book 36, Pages 14 and 15, Public Records of Pinellas View Ln. County recorded -in -the office records book 6156, page 1275, of the 09-29-16-45126-W3-0020 public records of Pinellas County, Florida. 3127 Wolfe Rd. Bay View Bluff lots H and 1 09-29.16-05310-000-0080 +b A fM + x a e t Ordinance No. 9060-17 Legal Descriptions ANX2017- 06013 Exhibit A Address Legal Description _ No. Parcel td 809 Glen OakLot 6, Block C, KAPOK TERRACE, according to the plat thereof as Ave E. recorded in Plat Book 36, Pages 14 and 15, Public Records of Pinellas 09-29-16-45126-003-0460 County, Florida: ... ..... 907 Glen Oak Lot 9, Block C, KAPOK TERRACE, according trzthe map or plat thereof, as recorded in Plat Book 36, Pages):14 and 15, of the Public Records 09 -29 -16 -45126 -0Q3 -009D Ave E. of Pinellas County, Florida. 915 filen Oak lot 11, Block C, KAPOK TERRACE, a subdivision according to the plat Ave E. thereof recorded at Plat Book, Pagerri in the Public: Records of Pinellas rCounty, 09-29-16-45126-003=0110 Florida. 3053 Grand Lot 6, Block -W. KAPOK TERRACE, according to the map or plat View Ave. thereof as recorded in Plat Book 36, pages 14 and 15, PublicRecords 09-2946-45126-001-0060 . of Pinellas County, Florida. . Lot 14, Block 1, KAPOK TERRACE FIRST ADDITION, according to the 3058 Hoyt Ave. map or plat thereof, as recorded in Plat Bonk 49, Page 48 of the Public 09-29-16-45144-009-0140 Records of Pinellas County, Florida. Lot 11, Block A, KAPOK TERRACE, according to the Map or Plat thereof 3040 Merrill as recorded in Plat Book 36, Pages 15 and 15, Public Records of Ave Pinellas County, Florida A/K/A/ 3040 Merrill Avenue, Clearwater, FL 09-2946-45126-001 -0110 33759 3077 Merrill. Lot 2, Block 1, KAPOK TERRACE FIRST ADDITION, according to the map or plat thereof, as recorded in Plat Book 49, Page 48, of the Public 09-29-16-45144-009-0020 Ave. Records of'Pinellas County, Florida. 3136'San lase Lot 56, DEL ORO GARDENS, according to the map or plat thereof as St. recorded in Plat Book 45, Page 74, Public Records of Pinellas County, 09-29-16-20808-000-0560 Florida. Lot 2, Block C, KAPOK TERRACE, according to the Plat thereof, as 3080 Terrace recorded in Plat Book 36, Pages 14 and 15, Public Records of Pinellas09-29-16-45126-00-0020 View.Ln. County recorded in the office records book 6156, page 1275, of the public records of Pinellas County, Florida. 3127 Wolfe Rd. Sav View Bluff Lots N and 1 09-29-16-05310-0Q0-0080 SAN JkATE0 ST ' Annexation Map Request Planner Name: Ellen Crandall Case Number: ANX2017-06013 Date Request Submitted: 6/2/17 Date Requested for: 6/16/17 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) f iu�t Kll I Required Documents ® Legal Descriptio warr y deed or survey) - to be hand delivered ® Map with Propos ite Highlighted ® EDR - no hard copies submitted - all submission material is accessible through Accela Location & Right -of -Way Language (for Ordinance Title) Location: 2.138 acres located generally north of Drew Street, south of SR 590, and within 'Amile west or east of McMullen Booth Road. Right -of -Way: [[ENGINEERING INSERT ROW DESCRIPTION OR N/A HER PROVIDED LEGAL DESCRIPTION VERIFIED BY: Thomas Mahony, PSM, MAP NAME Owner(s): Multiple Owners, See Attached Sheet Case: Manager ANX2017-06013 Property Site: Multiple Addresses, See Attached Sheet Size(Acres): ROW (Acres): Land Use From : RL / RU Zoning PIN: Multiple PINS, See Attached Sheet R-3 To: RL / RU LMDR I Atlas Page: I 283A