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ANX2017-08016PO' � 283A g ANX2017-08016 DRC: 9/7/17 I� CClst: 10/19/17 CC2nd: 11/2 -�, Ordinance #s: -17 -17 -17 Address No. Parcel ID. Owner 1 Glen Oak Avenue East 911 09-29-16-45126-003-0100 Charles W. Eason, Betty L. Eason 2 Glen Oak Avenue East 917 09-29-16-45126-003-0120 Mike Moore Anderson 3 Glen Oak Avenue North Richard Greif, 3025 09-29-16-45126-005-0070 Margaret Greif Glen Oak Avenue North 4 3061 09-26-16-45126-005-0010 Patricia M. Moore 5 Grand View Avenue 3026 09-29-16-45126-007-0090 James S. Baker 6 Hoyt Avenue 3053 09-26-16-45144-010-0060 John W. Patton, Carol Dawn Patton 7 Merrill Avenue 3071 09-29-16-45144-009-0030 Pamela A. Furst DRC: 9/7/17 I� CClst: 10/19/17 CC2nd: 11/2 -�, Ordinance #s: -17 -17 -17 ANX2017-08016 Address No. Parcel ID. Owner Glen Oak Charles W. Eason, 09-29-16-45126-003-0100 Avenue East 911 Betty L. Eason Glen Oak Mike Moore 09-29-16-45126-003-0120 Avenue East 917 Anderson Glen Oak Richard Greif, Avenue North 09-29-16-45126-005-0070 Margaret Greif 3025 Glen Oak Avenue North 09-26-16-45126-005-0010 Patricia M. Moore 3061 Hoyt Avenue John W. Patton, Carol 09-26-16-45144-010-0060 3053 Dawn Patton Merrill Avenue 09-29-16-45144-009-0030 Pamela A. Furst 3071 DRC: 9/7/17 CClst: 10/19/17 CC2nd: 11/2 Ordinance #s: -17 -17 -17 283A t . CLEARWATER BRIGHT AND BEAUTIFUL- BAY TO 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 NONCONTIGUOUS (TYPE A ENCLAVE) To Be Completed By Property Owner. PROPERTY OWNER (PER DEED): Charles W Eason, Betty L Eason MAILING ADDRESS: 911 Glen Oak Ave E PHONE NUMBER: 727-797-9183 EMAIL: cweason@verizon.net AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 911 Glen Oak Ave E PROPERTY: PARCEL NUMBER(S): 09-29-16-45126-003-0100 LEGAL DESCRIPTION: KAPOK TERRACE SUB BLK C, LOT 10 SOLhE/ CURRENT CITY SERVICES: SANITARY SEWER RECYCLING' jC W R OLID WASE/ REQUESTED CITY SERVICES: x SANITARY SEWER XC RECYCLING }C W R (select atl that apply) Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, Fl- 33756, Tel: 727-562-4567; Fax: 727-5624865 Page 1 of 7 Revised 02H6 / G-�CLEARWATER BRIGHT AND BEAUTIFUL- 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, One, Two, Three Family Residential REQUESTED (CITY): Low Medium Density Residential (LMDR) SITE AREA: 0.19 acres SIZE OF DEVELOPMENT: Existing: 1 Proposed: (e.g., number of units, hotel rooms or non- residential square footage) USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; plus existing if to remain): if residential use, is unit(s), rental? Single Family Single Family ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? YES ❑ NO IF YES, PLEASE LIST/EXPLAIN: STATE OF FLORIDA, COUNTY OF PINELLAS I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application. Sworn to and subscribed before me this 2-+I-' day of JZ'J20 n by atal,l,j Eric, Charles ErSw . who is personally known/has produced --'i V Gr.S Lic-u►SG as identification. Signature of property owner or representative 12 Notary public, ..V TANIAVASQUEZ - MY COMMISSION # GG My commission expire q �, fllayo s'�T EXPIRES: August 14, Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562.4567; Fax: 727-562-4865 Page 2 of 7 ReViieed 02/16 Signature of property owner or representative ..�CLEARWATER ' BRIGHTAND BEAUTIFUL- BAYTO REACH 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 exteis.myclearwater.com/Zoning. Planning & Development Department, 100 S. Myrtle Avenue :Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 3 of 7 1 Revised 02/16 ❑ 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/. CLEARWATER r BRIGHT AND BEAUTIFUL- BAY TO REACH ATTENDANCE AT PUBLIC HEARINGS Planning & Development Department Petition for Annexation Information for Applicants The applicant or applicant's representative is encouraged to attend City Council public hearings unless the annexation pertains to a property developed or to be developed with one single family dwelling. STANDARDS FOR ANNEXATION In determining whether to annex a property, the City shall consider the extent to which: ❑ The proposed annexation will impact public services (e.g., water, sewer, police, parks, etc.). ❑ The proposed annexation is consistent with the City of Clearwater Comprehensive Plan. ❑ The proposed annexation requires a change in the future land use and zoning classifications assigned to the property as well as the jurisdiction for said change. ❑ Existing or proposed development is consistent with City regulations. ❑ Terms of a proposed Annexation Agreement, if any, promotes the City of Clearwater Comprehensive Plan. PROPERTY OWNER AGREEMENT Please be advised that, in consideration of the annexation, the property owners do hereby agree that: ❑ All structures and improvements which are erected upon said property subsequent to the date of this petition for annexation shall comply with all applicable City of Clearwater regulations and ordinances as set forth in the City Community Development Code; ❑ All residential rental units, including single-family residences must comply with the requirements in the city's residential rental ordinance, which requires the property owner to obtain a Business Tax Receipt upon annexation into the city; ❑ If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plat, and engineering plans shall be submitted to ensure compliance with the city's Community Development Code (see Submittal Package Instructions Checklist). It is recommended that the applicant meet with Planning and Development Department staff to review plans and/or discuss the applicable city regulations; ❑ All annexations of residential dwellings of eight dwelling units or more shall convey such recreation facilities fees and recreation land dedication and/or fees in the amount and manner prescribed by Chapter 54, Article II of Clearwater Code of Ordinances; and ❑ When any substandard abutting street or utilities are subsequently upgraded by the City to meet City Standards, said improvement(s) will be done on an assessment basis, consistent with City procedures therefore. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 4 of 7 Revised 02/16 Planning & Development Department G�JCLEARWATER 131UGHT AND BEAUTIFULIIAY TO MACH Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Charles W Eason, Betty L Eason MAILING ADDRESS: 911 Glen Oak Ave E PHONE NUMBER: 727-797-9183 EMAIL: cweason@verizon.net AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: INTEREST IS: SPECIFIC INTEREST HELD: CIES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? YES ( NO CONTRACT IS: PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? YES ( NO PARTIES INVOLVED— NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY?, YES NO PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: STATE OF FLORIDA, COUNTY OF PINELLAS I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application. Sworn to and subscribed before me this 24+` day of ton by 19e++,1 Ccsr . Ch&rler Ga4q, , who is personally known/has produced DrN er.S U c em4e as identification. Signature of property owner or representative TANIAVASQUEZ 1MY MMISSiON # GG Notary publi EXPIRES: XWst 14,: 80ndsd Thru NctW Public Ui My commission ires:'t Signature of properter or representative �`�f"� Planning &Development Department, 100 S. Myrtle Avenue, Clearw ter,FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 5 of 7 t" Revised 02/16 _6,7--n'CLEARWATER BRICHT AND BFAUMUL • BAY TO Bf.ACH Planning & Development Department Petition for Annexation Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed —PRINT full names: Charles W Eason, Betty L Eason 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 911 Glen Oak Ave E 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 necesZry to affect such petition; 5. That this affidavit has been executed to induce the City of Clearwate lorida to consider and act on the above described property; 6. That site visits to the property are necessary by City representa es in order to process this application and the owner authorizes City representatives to visit and photograph a property described in this application; 7. That (1/we), the undersigned authority, hereby certify thatAe foregoing is true and correct. Charles W Eason Property Owner Betty L Eason Property Owner BEFORE ME THE UNDERSIGNED THIS DAY OF� Property Owner Property Owner OF FLORIDA, COUNTY OF PINELLAS OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND SAOTHAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary SeOTStamp Notary Public Signature My Commission Expires: Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 6 of 7 Revised 02/16 z:�)CLEARWATER BRIGHT AND BU nFM- MYTO BFACH PROPERTY OWNER (PER DEED): Charles W Eason, Betty L Eason MAILING ADDRESS: 911 Glen Oak Ave E CITY OF CLEARWATER CASE NUMBER: Planning & Development Department Petition for Annexation Supplemental Statement I/we, _ Charles W Eason, Betty L Eason [insert names of all property owners], having filed a Petition for Annexation regarding the above property/case number, grant consent, agree and acknowledge that the City of Clearwater may immediately or at a later time process the application to completion, including adoption and recordation of related Ordinances, without the necessity to further notice me/us. This Supplemental Statement shall supersede any provision in any Agreement to Annex executed by me/us.or my/our predecessors in interest. Select One Option Below Which Applies to This Petition for Annexation: ❑ Annexation of Contiguous Parcel(s): I/we further agree and acknowledge that I/we shall not rescind the Petition for Annexation or execute any documents attempting such rescission, and that any attempted rescission shall be of no force and effect. 0 Annexation of Noncontiguous Parcel(s): I/we understand that this annexation is voluntary, and that I/we may withdraw this Petition for Annexation prior to final action on this Petition by the City of Clearwater. I/we further 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 2 4-"" day of Signature of property owner (individual or authorized representative of corporation, partnership or other entity) Signature of owner OZ. -I 2011 . by (3eHy Eason , G'w L -s EM501" who is personally known/has produced F-= Dr. uc-�s Livens -e as identification. (votary public, My commission expires: 4�imi4'' TANIAVASQUE �`� -11 1= MY COMMISSION # GG 020834 EXPIRES: August 14, 2020 B=W Thi+ Nom' Public Urklerwdtem 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 =='�I•/CLEARWATER tJ BRIGHT AND BFAUTHUL•BAYTOSEACH 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): Mike Moore Anderson MAILING ADDRESS: 917 Glen Oak Avenue E, Clearwater, FL 33759 PHONE NUMBER: 743-0847 EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 917 Glen Oak Avenue E, Clearwater 33759 PROPERTY: PARCEL NUMBER(S): 09-29-16-45126-003-0120 LEGAL DESCRIPTION: Lot 12, Block C, Kapok Terrace Subdivision 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 1 ` �ICLEARWATER "•J BRIGHTAND BEAUnnJL• 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): 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: 0.300 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residential square footage) acres USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; plus existing if to remain): If residential use, is units) rental? Single Family Single Family NO ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? YES ❑ IF YES, PLEASE LIST/EXPLAIN: STATE OF FLORIDA, COUNTY OF PINELLAS • PI 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 (� h day of J14 IV . -20) by i ke moo IV Ahd ei'SO n who is personally known/has produced FL DL as identification. Signature of property owner or representative MYRAJAMES ary p#blic,; �' • Commission # GG 088045 My Comrli. Expires Mar 28, 2021 commission expires:'�oFF Bonded through National Notary Assn. Signature of property owner or representative Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 2 of 7 Revised 02/16 7' �- ICLEARWATER BBIGHT AND BFAUnRX-BAYTD BFACH 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.ore. ❑ FUTURE LAND USE PLAN DESIGNATION (COUNTY) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http:/Igis.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://gis.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 exteis.myclearwater.com/Zonine. ❑ SITE AREA (ACRES) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://eis.pinellascounty.org/public eis/. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-5624567; Fax: 727-562-4865 Page 3 of 7 Revised 02116 1 , �\��-��j',''��yCLEARWATER V BRIGMANDBFAUnML•BAYTOBFAM ATTENDANCE AT PUBLIC HEARINGS Planning & Development Department Petition for Annexation Information for Applicants The applicant or applicant's representative is encouraged to attend City Council public hearings unless the annexation pertains to a property developed or to be developed with one single family dwelling. STANDARDS FOR ANNEXATION In determining whether to annex a property, the City shall consider the extent to which: ❑ The proposed annexation will impact public services (e.g., water, sewer, police, parks, etc.). ❑ The proposed annexation is consistent with the City of Clearwater Comprehensive Plan. ❑ The proposed annexation requires a change in the future land use and zoning classifications assigned to the property as well as the jurisdiction for said change. ❑ Existing or proposed development is consistent with City regulations. ❑ Terms of a proposed Annexation Agreement, if any, promotes the City of Clearwater Comprehensive Plan. PROPERTY OWNER AGREEMENT Please be advised that, in consideration of the annexation, the property owners do hereby agree that: ❑ All structures and improvements which are erected upon said property subsequent to the date of this petition for annexation shall comply with all applicable City of Clearwater regulations and ordinances as set forth in the City Community Development Code; ❑ All residential rental units, including single-family residences must comply with the requirements in the city's residential rental ordinance, which requires the property owner to obtain a Business Tax Receipt upon annexation into the city; ❑ If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plat, and engineering plans shall be submitted to ensure compliance with the city's Community Development Code (see Submittal Package Instructions Checklist). It is recommended that the applicant meet with Planning and Development Department staff to review plans and/or discuss the applicable city regulations; ❑ All annexations of residential dwellings of eight dwelling units or more shall convey such recreation facilities fees and recreation land dedication and/or fees in the amount and manner prescribed by Chapter 54, Article II of Clearwater Code of Ordinances; and ❑ When any substandard abutting street or utilities are subsequently upgraded by the City to meet City Standards, said improvement(s) will be done on an assessment basis, consistent with City procedures therefore. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 4 of 7 Revised 02/16 �CLEARWATER BRIGHT AND BEAUTIFUL- BAYTO BEACH PROPERTY OWNER (PER DEED): Mike Moore Anderson Planning & Development Department Petition for Annexation Disclosure Statement MAILING ADDRESS: 917 Glen Oak Avenue E, Clearwater, FL 33759 PHONE NUMBER: 743-0847 EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS HAVING ANY OWNERSHIP !INTEREST IN THE SUBJECT PROPERTY: NAME: IN tn� INTEREST IS: SPECIFIC INTEREST HELD: DOES.A CONTRACT EXIST FOR 'SALE OF THE'SUBJECT PROPERTY? YES x NO CONTRACT IS: X70:$ h101 a-)�1Sl PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? PARTIES INVOLVED — NAME: NAME: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? _K YES PARTIES INVOLVED — NAME: wel's fc�-r5o PHONE NUMBER: NAME: 0 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 �h day of by 9_ Aske Ae A/d& S-6 h • who is personally known/has produced r L �- as identification. Signature of property owner or representative MYRA JAMES �o,�'� PU; �'•, Notary Public - State of Florida Notary p My commission expires: lic, = • : • € ommis My comm, Expires Mar 28, 2021 'Fovc� bondddthrough NatlonalNotary Asim, �w Signature of property owner or representative Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 5 of 7 Revised 02/16 A CLEARWATER Planning & Developmen epartment BIUCW AND BLAMML BAY TO RMCH Petition for nexation Affidavit to Authorize Agent/Re esentative 1. Provide names of all property owners on deed —PRINT full names: Mike Moore Anderson 2. That (I am/we are) the owner(s) and record title holder(s) of the following desc bed property: 917 Glen Oak Avenue E, Clearwater FL 33759 3. That this property constitutes the property for which a request for (descr' a request): Annexation in order to receive solid waste and sanitary sewer service rom the City. 4. That the undersigned (has/have) appointed and (does/do) appo' t: N `> as (his/their) agent(s) to execute any petitions or other d uments necessary to affect such petition; 5. That this affidavit has been executed to induce the Cit of Clearwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by Ci representatives in order to process this application and the owner authorizes City representatives to visit an hotograph the property described in this application; 7. That (1/we), the undersigned authority, hereb certify that the foregoing is true and correct. Mike Moore Anderson Property Owner Property Owner THIS Property Owner STATE OF FLORIDA, COUNTY OF PINELLAS Property Owner BEFORE ME THE UNDERSIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON OF PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND, AYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Sea Notary Public Signature My Commission Expires: Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 6 of 7 Revised 02/16 C�CLEARWATER BRIGHT AND BFAtMFUL• BAY TOBF.ACH PROPERTY OWNER (PER DEED): Mike Moore Anderson Planning & Development Department Petition for Annexation Supplemental Statement MAILING ADDRESS: 917 Glen Oak Avenue E, Clearwater, FL 33759 CITY OF CLEARWATER CASE NUMBER: I/we, _Mike Moore Anderson [insert names of all property owners], having filed a Petition for Annexation regarding the above property/case number, grant consent, agree and acknowledge that the City of Clearwater may immediately or at a later time process the application to completion, including adoption and recordation of related Ordinances, without the necessity to further notice me/us. This Supplemental Statement shall supersede any provision in any Agreement to Annex executed by me/us or my/our predecessors in interest. Select One Option Below Which Applies to This Petition for Annexation: ❑x Annexation of Contiguous Parcel(s): I/we further agree and acknowledge that I/we shall not rescind the Petition for Annexation or execute any documents attempting such rescission, and that any attempted rescission shall be of no force and effect. ❑ Annexation of Noncontiguous Parcel(s): I/we understand that this annexation is voluntary, and that I/we may withdraw this Petition for Annexation prior to final action on this Petition by the City of Clearwater. I/we further agree and acknowledge, however, that receipt of all sewer, solid waste or other city service is contingent upon completion of the Petition for Annexation process, and that any withdrawal of this Petition prior to final action by the City, may result in a discontinuance and termination of all City -provided services. STATE OF FLORIDA, COUNTY OF PINELLAS I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this applicatiofn. h Sworn to and subscribed before me this (o day of VLf I /by 114 yr ' kejg0Pre u �°�SOh who is personally known/has produced fL DL as identification. Signature of property owner (individual or authorized representative of corporation, partnership or other entity) Iry pulc, 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 02/16 ..i CLEARWATER _ BBICHT MD BFAU'HF -MYTO BTACH 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): Richard & Margaret Greif MAILING ADDRESS: 3025 Glen Oak Avenue, N, Clearwater, FL 33759 PHONE NUMBER: 796-7596 EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 3025 Glen Oak Avenue, N PROPERTY: PARCEL NUMBER(S): 09-29-16-45126-005-0070 LEGAL DESCRIPTION: Lot 7, Block E, Kapok Terrace Subdivision SOLID WASTE/ CURRENT CITYSERWCES: 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 CLEARWATER r BRIGHT AND BEAUTWM- BAY TD 8MrH zc 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: 0.248 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residential square footage) R-3 Single Family Residential Low Medium Density Residential (LMDR) acres USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; plus existing if to remain): if residential use, is unit(s)', rental? ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? IF YES, PLEASE LIST/EXPLAIN: STATE OF FLORIDA, COUNTY OF PINELLAS Single Family Single Family 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 ca ( day of O ( . by e� who is personally known/has produced'-t—L UL.. as identification. �C�0� U=A� — O Signature of propertq owner or representative il ��•3(p C* IFS C Q • a-� l •�I Notary public, My commission re of propefty owner or representative NotaBPPub�;nn #`�G 03'a'202U MV comm�Expi�es e�` ` n ,.,,�n Nai�ona� Nom Planning & Development Department, 100 S. Myrtle Avenue,�a ,�;1=L 38 362-4567; Fax: 727-662-4866 Page 2 of 7 Revised 02/16 0 CLEARWATER Planning & Development Department DBIGHT AND BEAU MM • BAYTO BEACH 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.pineliascounty.org/public gis/. Search by property address or Parcel I.D. Number and report will appear. ❑ FUTURE LAND USE PLAN DESIGNATION (CITY) is typically the same as the land use designation in Pinellas County, unless applicant is proposing a change (see submittal package requirements for more information). ❑ ZONING DISTRICT (COUNTY) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://gis.pinellascounty.org/public gis/. ❑ ZONING DISTRICT (CITY) can be found by contacting the Planning and Development Department or viewing the City's Zoning Atlas, available online at extgis.myclearwater.com/Zoning. ❑ SITE AREA (ACRES) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://gis.pinellascounty.org/public gis/. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 3 of 7 Revised 02116 CLEARWATER BRIGHT AND BEAlT RM-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; Fax: 727-562-4865 Page 4 of 7 Revised 02116 (17-�-�ICLEARWATERPlanning g�CB�BAY7OBEhCH & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Richard & Margaret Greif MAILING ADDRESS: 3025 Glen Oak Avenue, N, Clearwater, FL 33759 PHONE NUMBER: 796-7596 EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: None 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? YES X 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 Sworn to and subscribed before me this o(1 day of aW9 by f q e -F Innr-e—Ot who is personally known/has i lYtChard produced tl— (;-'(.e�tj'ly \ 3ln 33�o as identification. Si nature of propert owner or repres ative °1 ��((� t^�tcgckc eA - G(1c)S�0ya�ayd ulil•�1/Q0411 , lb LP • ati �-\ a I Notary publicij. _ My commission expires: +" ature of prope owner or representative ate o1 1973 :i~s •c't �UiY�n}i$S.-.n : Ct23, 20i • ,: � te5 � S Planning & Development Department, 1 •00 S. Myrtle Avenue, Clea r, 37�@u Ts1:1721-"5sl, -562-4865 Page 5 of 7 b�ryTF OF Revised 02/16 CLEARWATER Planning & Development Department BRIGHT AND 8EAV37FUL• 811YT0 BEACH Petition for Annexation Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed —PRINT full names: Richard Greif Margaret Greif 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 3025 Glen Oak Avenue, N, 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 cessary to affect such petition; 5. That this affidavit has been executed to induce the City of Clea ater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by City repres ntatives in order to process this application and the owner authorizes City representatives to visit and photogr ph the property described in this application; 7. That (1/we), the undersigned authority, hereby certify at the foregoing is true and correct. Richard Greif Property Owner Property Owner Margaret Greif Property Owner Property Owner THIS 'ATE OF FLORIDA, COUNTY OF PINELLAS BEFORE ME THE UNDERSIGNED/AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON DAY 0 PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND SAY,, THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Public Signature Notary SeaVttamp 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 (711 �CLEARWATER BIDOHT AND BBAUTWU -BAY TO BRACH Planning & Development Department Petition for Annexation Supplemental Statement PROPERTY OWNER (PER DEED): Richard & Margaret Greif MAILING ADDRESS: 3025 Glen Oak Avenue. N. Clearwater. FL 33759 CITY OF CLEARWATER CASE NUMBER: I/we, _Richard & Margaret Greif [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): [/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 o`Z 1 day of .by -C-e'0'- b _�� `S G('e \,q who is personally known/has �kC) _IL113 6331 O < X produced (- �i tpo P' cl- li--56 as identification. Si na ure of property 6wner (individual o uthorized t`1,4—_,,m6tC6c- G Lo1b S^1 OU a representative of corporation, partnership or other () O g LkA ° entity) k RoLLVA�t_ I ,�nN Notbr-y public, 59P4 A 11a °� llIsi1 My commission expir racy P"b\kC M GG p39s.?020 ' �Eera, pW--ISS$�� of co-praperty 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 �N C--;---)CLEARWATER BHIGHTMDBEA MnX-BAYT0BEACH 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): Patricia M. Moore NONCONTIGUOUS (TYPE A ENCLAVE) MAILING ADDRESS: 3061 Glen OakP4#e North PHONE NUMBER: y^' '7— -S"13° CjP EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: 41)6 ADDRESS OF SUBJECT 3061 Glen Oak Dtive North PROPERTY: PARCEL NUMBER(S): 09-29-16-45126-005-0010 LEGAL DESCRIPTION: Kapok Terrace Sub Block E, Lot 1 SOLID WASTE/ CURRENT CITYSERVICES: SANITARY SEWER RECYCLING ✓ WATER SOLID WASTE/ REQUESTED CITY SERVICES-' ✓ 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 \ r 7 BRIGHT AND BEAUnFUL• 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 SITE AREA: 0.23 PRESENT (COUNTY) REQUESTED (CITY) Residential Low (RL) Residential Low (RL) ZONING DISTRICT PRESENT (COUNTY): R-3 REQUESTED (CITY): Low Medium Density Residential (LMDR) SIZE OF DEVELOPMENT: Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residential square footage) acres USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; plus existing if to remain): If residential use, is units) rental? Single Family detached home N/A N0 RE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY?i 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. ,./A Sworn and subscribed before me this 2,9 day of AAZ01-7 by A�IZIGt r I 11 10 0who is personally known/has C--pre4uced fiZiZ400 R-alLa- LJCC-1"5'-- _ as identification. Signature of property owner or representative Notary public, My commission expires: Signature of property owner or representative PETER D. FARRAR Notary Public - State of I My Comm. Expires Sep 1312020 Bonded through National Notari Assn. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 2 of 7 Revised 08.18.2016 -- ICLEARWATER 1'-7BBtCfMDBFAUnWL-MYT013BACH Planning & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Patricia M. Moore ✓ f- , MAILING ADDRESS: 3061 Glen Oak QAve North e4 4A,4(vc �L. 3 3 PHONE N.UMRN `?Z'7 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 is 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? i/ YES NO PARTIES INVOLVED- NAME: -7 I." trryc� 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 applicatio SworTo nd subscribed before me this day of E: ZO 1-7 . by 14;)CI P M M 0 -0a -c- who is personally known/has -A-&Zre- ,ez hh u� oduced °�rr� p i �s L-ic c-�.�5� as identification. Signature of property owner or epresentative •"'��"'''• PETER D. FI -J.•.l►R��OB!i. of Florida Notary public, /Commission #F G 029761 My commission expires: l�~ ,� ��t My Comm. Expires S p 13. 2020 Signature of property owner or representative l Notary Assn. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 5 of 7 Revised 08.18.2016 CLEARWATER �__� BRIGHT AND BFAVI7FUL•BAYTOBEACft PROPERTY OWNER (PER DEED): Patricia M. Moore MAILING ADDRESS: 3061 Glen Oak Drive North CITY OF CLEARWATER CASE NUMBER: Planning & Development Department Petition for Annexation Supplemental Statement I/we, 9 Patricia M. Moore 5-- , 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 9,7+1_7) day of 1v . )/�) "_t' Signature of property owner (individual or authorized representative of corporation, partnership or other entity) Signature of co -property owner .7, 1 ;LD 17 by RAr iC11,c M, h�ecLe- who is personally known has produced Notary public, My commission expires: as identification. MY COMMISSION # GG 012512 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 $0 FEE: IMPACT TBD FEE/ASSESSME NT FEE: To Be Completed By City of Clearwater. TYPE OF ANNEXATION: x Information on Impact Fees orAssessment Fees is available from the City of Clearwater Engineering Department (562-4747). CONTIGUOUS NONCONTIGUOUS (TYPE A ENCLAVE) To Be Completed By Property Owner: PROPERTY OWNER (PER James S. Baker DEED): MAILING 3026 Grand View Avenue, Clearwater FL 33759 ADDRESS: PHONE NUMBER' 9,4-,C'2— ,4°15EMAIL: EMAIL: Ffm563@aol.com AGENT OR REPRESENTATI VE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 3026 Grand View Avenue Clearwater PROPERTY: Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 1 of 11 Revised 08.18.2016 PARCEL NUMBER(S): 09-29-16-45126-007-0090 LEGAL DESCRIPTION: Lot 9, Block G, Kapok Terrace Subdivision, plat book 36, page 14, public records of Pinellas County CURRENT CITY SERVICESY'. REQUESTED a rY SERVICES.',, (selead /I that 1.apply) SOLID WASTE/ SANITARY SEWER RECYCLING WATER SOLID WASTE/ SANITARY SEWER RECYCLING WATER Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 2 of 11 Revised 08.18.2016 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 Residential Low (RL) (CITY): ZONING DISTRICT PRESENT (COUNTY): R-3 REQUESTED Low Medium Density Residential (LMDR) (CITY): SITE AREA: SIZE OF DEVELOPMENT Existing: Proposed: (e.g., number of units, hotel rooms or non- residential square footage) ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS .COUNTY? IF YES, PLEASE LIST/EXPLAIN: 0.32 acres USE OF PROPERTY: Existing 1 dwelling unit (currently on Single Family Home site): n/a Proposed (new use, if any; YES F-1 NO d plus existing if N/A to remain): I f reside tial,' use, is init(s), ISD rental? t" Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 3 of 11 Revised 08.18.2016 STATE OF FLORIDA, COUNTY OF PINELLAS 1 i 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 / V day of Signa` ureb of property owner or representative i -i u S LA Za> by ,who is personally known/has produced —(Ih,,1trs %CC16S& as identification. Notary public, 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). Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 4 of 11 Revised 08.18.2016 My commission expires: / 1 " f C, Signature of property owner or �1p0.Y PUB e Ci DAVID W. GRIFFIN representative MY COMMISSION # FF 172108 40"; EXPIRES: November 14, 2018 _.P-d.A Th -Q -1-l. Akf-C-d-_ 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). Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 4 of 11 Revised 08.18.2016 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 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: Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 5 of 11 Revised 08.18.2016 ❑ 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 6 of 11 Revised 08.18.2016 PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBER: EMAIL: AGENT OR REPRESENTATI VE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS NAME: INTEREST IS: SPECIFIC INTEREST HELD: ,DOESA CONTRACT; EXIST FOR SALE OF THE SUBJECT PROPERTY? CONTRACT IS: PARTIES INVOLVED — NAME: ARE THERE ANY. OPTIONS TO PURCHASE. THE SUBJECT` PROPERTY? PARTIES INVOLVED — NAM E: Planning & Development Department Petition for Annexation Disclosure Statement NAME: Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 7 of 11 Revised 08.18.2016 YES PHONE NUMBER: ARE THERE ANY ". MORTGAGES OR LIENS ON YES THE, SUBJECT PROPERTY? c -GS t PARTIES PHONE INVOLVED — NAME: �ey� tf1�i f� �,� NUMBER: NAME: 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 Sigbi,ture of property owner or representative J Zo ►'7 by &4ait who is personally known/has produced _?�r�scvs (Cess' as identification. Notary public, My commission expires: Signature of �PRv Pus property owner 2°:"'•.`'� DAVID W. GRIFFIN * * MY COMMISSION # FF 172108 or EXPIRES: November 14, 2018 representative�l�TFOFF�°�\oe BondedThruButetNotarySenices —r!4--2-ac Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 8 of 11 Revised 08.18.2016 Planning & Development Department 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 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 necessary to affect such petition; 5. That this affidavit has been executed to induce the City of Clearwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by City representatives in order to process this application and the owner authorizes City representatives to visit and photograph the property described in this application; 7. That (1/we), the undersigned authority, hereby certify that the foregoing is true and correct. Property Owner Property Owner Property Owner Property Owner STATE OF FLORIDA, COUNTY OF PINELLAS BEFORE ME THE UNDERSIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON THIS DAY OF , PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Public Signature Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 9 of 11 Revised 08.18.2016 Notary Seal/Stamp My Commission Expires: I/we, James S. Baker having filed a Petition for Annexation regarding the above property/case number, grant consent, agree and acknowledge that the City of Clearwater may immediately or at a later time process the application to completion, including adoption and recordation of related Ordinances, without the necessity to further notice me/us. This Supplemental Statement shall supersede any provision in any Agreement to Annex executed by me/us or my/our predecessors in interest. Select One Option Below Which Applies to This Petition for Annexation: X♦ Annexation of Contiguous Parcel(s): I/we further agree and acknowledge that I/we shall not rescind the Petition for Annexation or execute any documents attempting such rescission, and that any attempted rescission shall be of no force and effect. ♦ Annexation of Noncontiguous Parcel(s): I/we understand that this annexation is voluntary, and that I/we may withdraw this Petition for Annexation prior to final action on this Petition by the City of Clearwater. I/we further agree and acknowledge, however, that receipt of all sewer, solid waste or other city service is contingent upon completion of the Petition for Annexation process, and that any withdrawal of this Petition prior to final action by the City, may result in a discontinuance and termination of all City -provided services. STATE OF FLORIDA, COUNTY OF PINELLAS I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application. Sworn to and subscribed before me this (S+ day of wf a S Z c'i by 1?yPycm who is personally known/has produced `t� rt4crs as identification. Signature of property owner (individual or authorized representative of corporation, partnership or other entity) Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 10 of 11 Revised 08.18.2016 Planning & Development Department Petition for Annexation Supplemental Statement PROPERTY OWNER James S. Baker (PER DEED): MAILING ADDRESS: 3026 Grand View Avenue, Clearwater FL 33759 CITY OF CLEARWATER CASE NUMBER: I/we, James S. Baker having filed a Petition for Annexation regarding the above property/case number, grant consent, agree and acknowledge that the City of Clearwater may immediately or at a later time process the application to completion, including adoption and recordation of related Ordinances, without the necessity to further notice me/us. This Supplemental Statement shall supersede any provision in any Agreement to Annex executed by me/us or my/our predecessors in interest. Select One Option Below Which Applies to This Petition for Annexation: X♦ Annexation of Contiguous Parcel(s): I/we further agree and acknowledge that I/we shall not rescind the Petition for Annexation or execute any documents attempting such rescission, and that any attempted rescission shall be of no force and effect. ♦ Annexation of Noncontiguous Parcel(s): I/we understand that this annexation is voluntary, and that I/we may withdraw this Petition for Annexation prior to final action on this Petition by the City of Clearwater. I/we further agree and acknowledge, however, that receipt of all sewer, solid waste or other city service is contingent upon completion of the Petition for Annexation process, and that any withdrawal of this Petition prior to final action by the City, may result in a discontinuance and termination of all City -provided services. STATE OF FLORIDA, COUNTY OF PINELLAS I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application. Sworn to and subscribed before me this (S+ day of wf a S Z c'i by 1?yPycm who is personally known/has produced `t� rt4crs as identification. Signature of property owner (individual or authorized representative of corporation, partnership or other entity) Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 10 of 11 Revised 08.18.2016 "Ay puaz DAVID W. GRIFFIN MY COMMISSION # FF MI * EXPIRES: November 14, 2018 Notary public, ��9TFOF F�o�\aQ Bonded 7htu Budget Notary Services My commission expires: (� •- (� --2A / Signature of co -property owner I Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 11 of 11 Revised 08.18.2016 C�CLEARWATER[��-�-,� j. V BRIGHT AND BF.AtMFUL• BAYTO BFACH 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): John W. & Carol D. Patton NONCONTIGUOUS (TYPE A ENCLAVE) MAILING ADDRESS: 3053 Hoyt Avenue, Clearwater, FL 33759 PHONE NUMBER: 403-6242 EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 3053 Hoyt Avenue, Clearwater 33759 PROPERTY: PARCEL NUMBER(S): 09-29-16-45144-010-0060 LEGAL DESCRIPTION: Lot 6, Block J, Kapok Terrace 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 C�CLEARWATER BRIGHT AND BEAUTIFUL• RAY 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 REQUESTED (CITY): Residential Low ZONING DISTRICT PRESENT (COUNTY): R-4 One, Two and Three Family Residential REQUESTED (CITY): Low Medium Density Residential SITE AREA: 0.185 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residential square footage) acres USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; plus existing if to remain): if residential use, is unit(s), rental? Single Family Single Family ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELYES ❑ 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 '2407M day of TUL4 . 200 . by of property owner or representative Signature of property owner or representative W • PA -M13 who is personally known/has pr tq d ffd2P OA as identification. N09YO —1c, ROBERTAGLUSKI ""P v P c`: Notary Public - State of Florida My commission expires commission #GG 067180 My Comm. txpires jan 29,2021 , '•.;;COF F� gonded 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 02116 4 „/CLEARWATER Planning & Development Department BRIGHT AND BFAUTIFl7[.•BAY T08FACH 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://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 htto://gis.i)inellascounty.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.orp./public gis/. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 3 of 7 Revised 02/16 �-CLEARWATER 7177 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; Fax: 727-562-4865 Page 4 of 7 Revised 02/16 C_--CLEARWATER V BRIGHT AND BEAUTIFUL•BAY To BEACH Planning & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): John W. & Carol D. Patton MAILING ADDRESS: 3053 Hoyt Avenue, Clearwater, FL 33759 PHONE NUMBER: 403-6242 EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME:---- ►�T i 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 x NO PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? YES NO PARTIES INVOLVED—NAME: CL-jc,s,*_ 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 2(.0-% day of �U V 2t� 17 by ({J vi . PA TT b who is personally known/has c as identification. Sign ure of property owner o`er r representative N��e. ✓"� ; =os Notary Public -State of Florida My co fission expires • ` Commissiot,-Mm Pinires #G 067182021 Signature of property owner or representative ,o�F ,'. Bonded through NationalNotaryAlsn. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 5 of 7 Revised 02116 ao�CLEARWATER Planning & Development Department BRIGHT AND BEAUTIFUL•BAY TO BEACH Petition for Annexation Affidavit to Authorize Agent/Repres " tative 1. Provide names of all property owners on deed — PRINT full names: John W. Patton Carol D. Patton 2. That (I am/we are) the owner(s) and record title holder(s) of the following described teIrty: 3053 Hoyt Avenue, Clearwater, FL 33759 3. That this property constitutes the property for which a request for (describe req st): Annexation in order to receive solid waste and sanitary sewer service from th City. 4. That the undersigned (has/have) appointed and (does/do) appoint: as (his/their) agent(s) to execute any petitions orXel en 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 tatives in order to process this application and the owner authorizes City representatives to visit andhe property described in this application; 7. That (1/we), the undersigned authority, hereby ceoregoing is true and correct. John W. Patton . Carol D. Patton THIS Notary Property Owner Property Owner STATE OF FLORIDA, COUNTY OF PINELLAS Property Owner Property Owner BEFORE ME THE UNDERSIGNED, AK OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON DEPOSED AND SAYS DAY OF PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN 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: 727-562-4567; Fax: 727-562-4865 Page 6 of 7 Revised 02/16 CLEARWATER �J BRIGHT AND BEAUTIFUL - BAYTO BEACH PROPERTY OWNER (PER DEED): John W. & Carol D. Patton MAILING ADDRESS: 3053 Hoyt Avenue, Clearwater, FL 33759 CITY OF CLEARWATER CASE NUMBER: Planning & Development Department Petition for Annexation Supplemental Statement I/we, _John W. and Carol D. Patton [insert names of all property owners], having filed a Petition for Annexation regarding the above property/case number, grant consent, agree and acknowledge that the City of Clearwater may immediately or at a later time process the application to completion, including adoption and recordation of related Ordinances, without the necessity to further notice me/us. This Supplemental Statement shall supersede any provision in any Agreement to Annex executed by me/us or my/our predecessors in interest. Select One Option Below Which Applies to This Petition for Annexation: Annexation of Contiguous Parcel(s): I/we further agree and acknowledge that I/we shall not rescind the Petition for Annexation or execute any documents attempting such rescission, and that any attempted rescission shall be of no force and effect. ❑ Annexation of Noncontiguous Parcel(s): I/we understand that this annexation is voluntary, and that I/we may withdraw this Petition for Annexation prior to final action on this Petition by the City of Clearwater. I/we further agree and acknowledge, however, that receipt of all sewer, solid waste or other city service is contingent upon completion of the Petition for Annexation process, and that any withdrawal of this Petition prior to final action by the City, may result in a discontinuance and termination of all City -provided services. STATE OF FLORIDA, COUNTY OF PINELLAS 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 2(Dfs{- day of J �Tr M PA4rM who is personally known/has /?Z' � �+ p ced IP 0/4 pR-1 lf[i1R-•S as identification. F of property owner (individual or authorized ntative of corporation, partnership or other entity) Signature of co -property owner Notary Public -State of Florida My commission expi t' Commission#6,067180 P:.... �,...,... C...,;� len 90 4m Bonded through NOMBI NOWYAM 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 } A �'�}�. }Jr�xl�,!Yi, �,+�:st I,Di�»-•�la�'acfial� TA�Q. ,..�.... 0..•.,.'.1. yl�:1�r ,, � r I) )�;:.• ¢��I. I �•�'�`R�, OFFICE of VITAL STATISTICS ~ r CERTIFIED COPY ic CAL FILE NO FLORIDA CERTIFICATE OF DFATN 1. DECEDENT'S NAME (r.W. Mddr, Us,, Sd&) 311, DATESIGNEO(mmV&yMy) - Carol Dawn Patton 12,S111 Female 3 DATE OF BIRTH (Mwth, Oay, Yasr) aa. AGF --Last ISAWday ab. UE 11 t Ac. UNU R 1 AY S. DATE OF DEATH (Mpnh, par year) Ifwm Macules 19. (Year.) 6B Atomns'nays David Wright,MD 3W. CERDFIEWS• STATE 36b. CIN OR TOWN July 25, 2009 6.SOLIAL SECURITYNUMBER T.BIRTHPLACE(Cily.WSlatewlwergn Cowmy) B.COUNTYOFDE'ATH Tampa Jenkins, Kentucky Pinellas PLACE OF OEATN HOSPITAL: - Inpall0nt _ Emer Roomlp (CMM Ony one) 9�cY utpafient -�Oeatl cin M"rvaI NON HOSPITAL. _ Hospice t -!;y _ Nwsing Term Caro F",Ay X pautdem'c Nome _ 011ier (Sper.'y/ 10. FACILITY NAME (1/rrolimM1ry.an, gin slMeladdress) 116. CITY. TOWN. OR LOCATION OF DEATH 11b. fNSIDE CITY LIMITS' 3053 Hoyt Avenue Clearwater g _Ywx _NO 12. MARITAL STATUS /SpcUy) 13. SURVIVING SPOUSE'S NAME la wde, pis -as. rwmc) X Marred _Ma1rk0, tut separated _Widawad _ORan"d _Neves hNvled John Patton 14i. RESIDENCE - STATE lab. COUNTY 14e. CITY, TOV/N, OR LOCATION Florida Pinellas Clearwater ITY LIN.ITS? lad. STREET AODRFSS tae. APT. NO. 1<1. ZIP GDOE tag, INSIDE -C-11111 30CE Hoyt Avenue 33759 X_Yes _No lSe Da a&ustT$VSNAL OCCUPATION(mNpafe type otwmed- daring mpale/wwMng Me) 161. RIND OF BUSINESSANOUSTgY On rid use'Raerop• Systems Programmer Computer /6. DECEDENTS RACE ($pedy the eacN2pes to indFate what Oecedanl ronsdeMd WMSgf, &,"d to he. Moro tMa ono race m.ybe spedfiedi XVJhb. _ Bleck w African American _ArPrican Indian er Alaskan N.1N.(Specilyfnbe) _Asbn 1n04n _Chirmae _Faipirp _Japanese _%wean _Vlef-se _ Omer Asian(Speciy) _WWII H -Van _Cwemaro.n er Cnamo'm _Samoan 01"t, PetTC III,(Speeiy) _ Odvr(.9paeliy) 17. T OF (AwD ffdNdfH su MIs DRHMnANORIGIN? _ Yes of YOs.,Peedy)-b _Mexican _Puerto Rican _Cuban _,CugtNI50Vm Am A,an (Sprb/ly adnvadenl was alHtspanc wMaMan Origin / _ Oft- Niv.'t (So..dy) Hn�lian 18. DECEDENTS EDUCATION (Speciy the dobodianIS highest dog" w level of school Wnlpleredat Luna ddeam.) _ 19. WAS DECEOENT EVER IN 818 w bs9 _High atl1p071,rrt ro apoma Y` HO schod diploma or GED U.S. ARMED FORCES? _ r nage Mtl no W Brea CO6o91 dngrao (Sorry): -A ssociate _ Oechel e. _ Mem s _ Opemme _ Yes X No 20. FATHER'S NAME (Firs) Mwee, Last, SYMa) 2t. MOTHER'6 NAME (First ,widen &rmnmpJ Whitaker. Sarah Louise Perkey ORV.AHT'S NAME 122v. RELATIONSHIP TO DECEDENT 23a. INFORMANT'S MAILING -STATE ohn Patton Spouse Florida Y Oq TOYJN 23c STREET ADDRESS 23d. 21P CODE learwater 3053 Hoyt Avenue 33759 CE OF DISPOSITION(NamO of -toy.. marc% or phar rAI a) 2Sa. LOCATION -STATE 25b. LOCATION• CRY OR TOWNay Area Crematory Florida Clearwater rhrnest T1000F DtSPOSITfON _Burial F�Iembmny Crematron DonetNm Removal b.m SlMa _OIAer (Sp[ti7y) REMATION, DONATION OR BURIAL AT SEA. 27xL'CENSE NleaBER (al(rtenasa) 2T1. 7 q UNERAL fiERVIC LICENSEEOR PERSON ACTING AS Sl1CH 6 MEDICAL E%A/AINERPROVAL GRANTED+ X Yea_ME OF FUNERAL FACILITY 298. F TTS MAILING - STATE ylvan Abbey Funeral Home Florida V OR TOWN 29c. STREET ADORES 23e, bP CODE learwater 7.853 Sunset Point Road 33759 ••�•��•.-_•r=r�»r„y•„aM+,a-.craw aesrm my.nP,v�eage, vnam dzurteo al me lune, pato anv Dracn,eM duv Wttw causet¢)arN manner stated. IrAnc4-1 Medical FerM-an m.Ina.borer*;.�r:......u.,.t.,,...r:,Ma..,ar,,.,..,w,.w..,w...........r....__._._�._�____._._..___..__._. 31..(610.. and TRle el IdeU 311, DATESIGNEO(mmV&yMy) 32. TIME OF DEATH (2e m.) 33. MEDICAL EJIAM.INEITS CASE NUMBER .. .. Zdoe� 0410 1 :Ne. 11f,ENSENUMBER(e/G 'ger) fiv %Se 34b.CERTIFIERBNAVE 35. NAME OF ATTENDING PHYSICIAN pfwhBl than Cvddad David Wright,MD 3W. CERDFIEWS• STATE 36b. CIN OR TOWN 7&. STREET AODFIESS _ 360. 21P CODE Florida Tampa 612 North Hah a 41 00 336111_ 37. S RTRAR • Stgnefum arM Dara uf^ • Bn l R � $ RA - I Halo YZ T1P1 F. FA.ED Y REGISTRAR •• Y1�W 7 0?•3/'uS {/� J TIME ABOVE SIGNATUREC( hief EDepyplly,Rtglgt.-at. i)pt iLqldfC, 6ijilly OFFICIAL RECORD ON FiL �r F I.II'M,,.,,F.�J%�:.,__:i QV ' 10,200 moi. ) TFIIS DOCUntEteT IS PRI14TED OR PHOTOCOPIED 014 SECURI i ! PAPER :4'iTH A PJATERE4ARn I He C: +b• HEALTHY I WARNING: SEAL OF THE STATE OF FLORIDA ON THE FRO141 AND THE BACK CONTAINS SPECIAL LINES WITH TEXT A140 SEALS IN THEW40CHROMIC INK. - V. ~. DH FORM1946 (08-04) I IIIIII VIII IIT Iilll Iilll VIII IIID VIII ILII ILII 41644096 «• i ap - - - - * 4 1 6 4 4 0 9 6 yFOi rO r!y IRI c 0 M .M D 10M A ' ,K<,rr nM>�1^,r,M = RAY R)z;.^clt 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): Pamela A. Furst MAILING ADDRESS: 3071 Merrill Avenue, Clearwater, FL 33759 PHONE NUMBER: 236-0229 EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 3071 Merrill Avenue, Clearwater 33759 PROPERTY: PARCEL NUMBER(S): 09-29-16-45144-009-0030 LEGAL DESCRIPTION: Lot 3, Block I, Kapok Terrace 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 Lai �'F,j, BTt10NT Ai�U IIP,i1l7FlFQL • 11RY 10 bKhCYi 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 One, Two and Three Family Residential REQUESTED (CITY): Low Medium Density Residential (LMDR) SITE AREA: 0.185 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residential square footage) acres USE OF PROPERTY: Existing (currently on site); Proposed (new use, if any; plus existing if to remain): If residential use; i8 unit(sj rental? Single Family Single Family IDt-� V-- ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PIN,EaLLAS COUNTY'S YES ❑ IF YES, PLEASE LIST/EXPLAIN: STATE OF FLORIDA, COUNTY OF PINELLAS NO Z' 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. 15fSworn to d subscribed before me thiis� �-7 ` day of . AIM 'f by yowylc& L(.r5 who ' ersonally kno n/has produced as identification. Signature of property owner or representative / 1 n A „ 1 A n Noary public, My commission expires: Signature of property owner or representative JUANALECHA MCCULLOUGH Expires February 27, 2019 Bw4W Thu T w Faro Ins m= 800385.7019 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 2 of 7 Revised 02116 �,-,��,'ICLEARVVATER. t i RICHTADBYA1111M U.- RAY i'DRIACH 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 02116 •'; t1RI4F71'RYl)A};AI7R['I:E.[fAY'[41 Ri:AL"[{ ATTENDANCE AT PUBLIC HEARINGS Planning & Development Department Petition for Annexation Information for Applicants The applicant or applicant's representative is encouraged to attend City Council public hearings unless the annexation pertains to a property developed or to be developed with one single family dwelling. STANDARDS FOR ANNEXATION In determining whether to annex a property, the City shall consider the extent to which: ❑ The proposed annexation will impact public services (e.g., water, sewer, police, parks, etc.). ❑ The proposed annexation is consistent with the City of Clearwater Comprehensive Plan. ❑ The proposed annexation requires a change in the future land use and zoning classifications assigned to the property as well as the jurisdiction for said change. ❑ Existing or proposed development is consistent with City regulations. ❑ Terms of a proposed Annexation Agreement, if any, promotes the City of Clearwater Comprehensive Plan. PROPERTY OWNER AGREEMENT Please be advised that, in consideration of the annexation, the property owners do hereby agree that: ❑ All structures and improvements which are erected upon said property subsequent to the date of this petition for annexation shall comply with all applicable City of Clearwater regulations and ordinances as set forth in the City Community Development Code; ❑ All residential rental units, including single-family residences must comply with the requirements in the city's residential rental ordinance, which requires the property owner to obtain a Business Tax Receipt upon annexation into the city; ❑ If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plat, and engineering plans shall be submitted to ensure compliance with the city's Community Development Code (see Submittal Package Instructions Checklist). It is recommended that the applicant meet with Planning and Development Department staff to review plans and/or discuss the applicable city regulations; ❑ All annexations of residential dwellings of eight dwelling units or more shall convey such recreation facilities fees and recreation land dedication and/or fees in the amount and manner prescribed by Chapter 54, Article II of Clearwater Code of Ordinances; and ❑ When any substandard abutting street or utilities are subsequently upgraded by the City to meet City Standards, said improvement(s) will be done on an assessment basis, consistent with City procedures therefore. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 4 of 7 Revised 02/16 r"�-77 _ Planning & Development Department ARIGH ANDBI:AlYrI 1[., BAY TORFAC[{ Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Pamela A. Furst MAILING ADDRESS: 3071 Merrill Avenue, Clearwater, FL 33759 PHONE NUMBER: 236-0229 EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ...... OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE:SU"BJECT PROPERTY: ...... .... _. _ NAME: r" (A - INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FORS A LE OFT HE SUBJECT PROPERTY? YES NO CONTRACT IS: n), �— PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? YES NO PARTIES INVOLVED—NAME: nf'�1 PHONE NUMBER: NAME: PHONE NUMBER: ARE THEREVANY: MORTGAGES OR LIEN S'ON THE SUBJECT PROPERTY? YES NO PARTIES INVOLVED —NAME: PHONE NUMBER: NAME: PHONE NUMBER: STATE OF FLORIDA, COUNTY OF PINELLAS I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application. Sworn to and subscribed before me this day of . by who is personally known/has produced as identification. Signat a of property owner or representative Notary public, My commission expires: Signature of property owner or representative Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 5 of 7 Revised 02116 Planning & Development Department .4„,,.,,Ta>„-r,,,1,:,..MIII ,,-,t Petition for nexation Affidavit to Authorize Agent/RepA sentative 1. Provide names of all property owners on deed -PRINT full names: Pamela A. Furst 2. That (I am/we are) the owner(s) and record title holder(s) of the following describ property: 3071 Merrill Avenue, Clearwater, FL 33759 3. That this property constitutes the property for which a request for (describe equest): Annexation in order to receive solid waste and sanitary sewer service fro the City. 4. That the undersigned (has/have) appointed and (does/do) appoint: N� as (his/their) agent(s) to execute any petitions or other docu nts necessary to affect such petition; 5. That this affidavit has been executed to induce the City of earwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary b/phograph entatives in order to process this application and the owner authorizes City representatives to visit ath property described in this application;7. That (I/we), the undersigned authority, hereby e fo egoing is t e an I i Pamela A. Furst Property Owner U Property Owner Property Owner Property Owner ATE OF FLORIDA, COUNTY OF PINELLAS BEFORE ME THE UNDERSIGNED AN OFFICEtfR DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON THIS DAY OF U— 20 177 PERSONALLY APPEARED Gl. WHO HAVING BEEN FIRST DULY SWORN LLY UNDERST=TENTS THE AFFIDAVIT THAT HE/SHE SIGNED. ', ”" FExpiFebruary HAMCCULLOUGH.0 n # FF 198848-� 27,2019L '', Fein haurence 8003857019 Notary Public Signature Notary`Seal/Sta p My Commission Expires: a '�`�— —o�` 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 <mLEARWA ;EI. r ...... HT AM) AFAiJ1MA, BAY MACH PROPERTY OWNER (PER DEED): Pamela A. Furst Planning & Development Department Petition for Annexation Supplemental Statement MAILING ADDRESS: 3071 Merrill Avenue, Clearwater, FL 33759 CITY OF CLEARWATER CASE NUMBER: [/we, _Pamela A. Furst [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 tond subscrifbbed before me this day of j� tk by dPQ 08b' S 'who i rsona y kno /has (V ktK produced as identification. Signature of property owner (individual or authorized representative of corporation, partnership or other entity) ary public, commission expires: Signature of co -property owner C JUANALECHA MCCULLOUGH Expires February 27, 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 ORDINANCE NO. 9069-17 AN ORDINANCE OF THE CITY OF CLEARWATER, FLORIDA, ANNEXING CERTAIN REAL PROPERTY LOCATED GENERALLY NORTH OF DREW STREET, SOUTH OF SR 590, AND WITHIN % MILE WEST OF MCMULLEN BOOTH ROAD, WHOSE POST OFFICE ADDRESSES ARE 901, 911, AND 917 GLEN OAK AVENUE EAST, 3025 AND 3061 GLEN OAK AVENUE NORTH, 3026 GRAND VIEW AVENUE, 3046 AND 3053 HOYT AVENUE, 3065 AND 3071 MERRILL AVENUE, 911 MOSS AVENUE, AND TWO UNADDRESSED PARCELS MORE APPROPRIATELY KNOWN AS LAKE LOUISE AND LAKE CAROL, ALL IN CLEARWATER, FLORIDA 33759 INTO THE CORPORATE LIMITS OF THE CITY, AND REDEFINING THE BOUNDARY LINES OF THE CITY TO INCLUDE SAID ADDITION; PROVIDING AN EFFECTIVE DATE. WHEREAS, the owners of the real properties described herein and depicted on the map attached hereto as Exhibit B have petitioned the City of Clearwater to annex the properties into the City pursuant to Section 171.044, Florida Statutes, and the City has complied with all applicable requirements of Florida law in connection with this ordinance; now, therefore, BE IT 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; (ANX2017-07015, ANX2017-08016, ANX2017-08018) The map attached 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, parks, rights-of-way and other dedications to the public, which have heretofore been made by plat, deed or user within the annexed property. The City Engineer, 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 City 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. Ordinance No. 9069-17 PASSED ON FIRST READING Nov 1 6 2017 PASSED ON SECOND AND FINAL DEC 0 7 2017 READING AND ADOPTED Camilo A. Soto Assistant City Attorney —g1W(Ie t) Ch f-�XWS George N. Cretekos Mayor Attest: Rosemarie Call City Clerk Ordinance No. 9069-17 Exhibit A Address Legal Description No. Parcel ID. 901 Glen Oak Lot 8, Block C, KAPOK TERRACE, according to the plat Avenue East thereof, recorded in Plat Book 36, Pages 14 and 15, Public 09-29-16-45126-003-0080 Records of Pinellas County, Florida 911 Glen Oak Lot 10, Block C, KAPOK TERRACE SUBDIVISION, according Avenue East to the map or plat thereof as recorded in Plat Book 36, 09-29-16-45126-003-0100 page 14 of the Public Records of Pinellas County, Florida. 917 Glen Oak Lot 12, Block C, KAPOK TERRACE, according to the map or Avenue East plat thereof, as recorded in Plat Book 36, Pages 14-15, 09-29-16-45126-003-0120 Public Records of Pinellas County, Florida. 3025 Glen Oak Lot 7, Block E, KAPOK TERRACE, according to the plat Avenue North thereof, recorded in Plat Book 36, Page 14 and 15 of the 09-29-16-45126-005-0070 Public Records of Pinellas County, Florida. 3061 Glen Oak Lot 1, Block E, KAPOK TERRACE, according to Map or Plat Avenue North thereof as recorded in Plat Book 36, Pages 14 and 15, 09-26-16-45126-005-0010 Public Records of Pinellas County, Florida Unaddressed Grand View Kapok Terrace Subdivision Block G, Lake Louise and Park Avenue Area to west 09-29-16-45126-007-0140 (Lake Louise) 3026 Grand View Lot 9, Block G, KAPOK TERRACE SUBDIVISION, according to Avenue the plat thereof as recorded in Plat Book 36, Page 14, 09-29-16-45126-007-0090 Public Records of Pinellas County, Florida Lot 12, Block I, Kapok Terrace First Addition, according to 3046 Hoyt Avenue the map or plat thereof, as recorded in Plat Book 49, Pages 09-29-16-45144009-0120 48, of the Public Records of Pinellas County, Florida. Lot 6, Block J, KAPOK TERRACE, FIRST ADDITION, according 3053 Hoyt Avenue to the map or plat thereof as recorded in Plat Book 49, 09-26-16-45144010-0060 page 48, of the Public Records of Pinellas County, Florida. 3065 Merrill Lot 4, Block I, Kapok Terrace First Addition, according to the plat thereof, as recorded in Plat Book 49, Page 48, 09-29-16-45144009-0040 Avenue Public Records of Pinellas County, Florida Exhibit A Address legal Description No. Parcel ID. 3071 Merrill Lot 3, Block 1, KAPOK TERRACE FIRST ADDITION, according to the plat thereof, as recorded in Plat Book 49, Page 48, 09-29-16-45144009-0030 Avenue Public Records of Pinellas County, Florida. Unaddressed Kapok Terrace Subdivision Block F, Lake Carol and Park Moss Avenue Area in northwest corner of Block 09-29-16-45126-006-0070 (Lake Carol) A portion of Lot 2, Block F, Kapok Terrace, as recorded in Plat Book 36, Page 14 and 15, of the Public Records of Pinellas County, Florida, more particularly described as follows: Commence at the Pt of Lot 1 of said Block F, fronting on Moss Avenue (60' R.O.W.), thence S 01 degrees 07 minutes 32 seconds E, 49.98 feet to the Point of Beginning; thence continue S 01 degrees 07 minutes 32 seconds E, 39.18 feet along the 911 Moss Avenue Westerly right-of-way of said Moss Avenue to the PC of a curve 09-29-16-45126-006-0020 concave to the left, having a radius of 590 feet and a delta of 02 degrees 12 minutes 34 seconds, thence along said curve, 22.75 feet along said Moss right-of-way to a P.O.C.; thence S 85 degrees 36 minutes 30 seconds W, 133.56 feet; thence N 01 degrees 58 minutes 30 seconds W, 61.76 feet, thence N 85 degrees 27 minutes 50 seconds E, 134.4S feet to the said Westerly right-of-way of Moss Avenue, said point also being the point of beginning. I ?6 ZA a LAKE CAROL m t z1 22 1 N1 4D 2 off - - - - 3 06 21 20 7 • R 10 1° 17 to 15 1 I 13 GLEN OAK AVE N a „ 1 1 1[ b 110 0 I 1 1 3 2 1 I 1 10J D 0 10 11 12 13 14 W t 100 C y�At• * SEE I 1 9 197 2 a2 1 7 LAKE VISTA DR a H1 7 1t 12 Acp 5' 7 e S C I 3 2 70 tt 12 113 74 R 2 100 1 Ie1 e 77 Atlas Page: 283A I 4 ° 5 4 3 1 2 1 I O s 00t Exhibit B S y R 7{2 4 7 e o to H 3 22 ?g10 IS 3 13 Is 7i 17 1 5 a �a p a TERRACE VIEW LN a R 1 I LAKELOUISE e �ttY 7 4 3 2 70• 10 • 03 2 13 1 1121� 7t a GRAND VIEW AVE o I k I I Owner(s): Multiple Owners Case: e 5 1 9 197 2 a2 1 7 4.917 D 10 1t t2 e aL8825 1 O 1.4 Acp O 1.4 Acp PROPOSED ANNEXATION w Rev. GO W 7 ra 023 s Acp 1 1 I 33 1 34 1 35 1 1 1 1 1 1 SHIN AERNADINO I 1 32 1 31 30 17 1 13 11 1 S#N MATEO ST s 14 X13 �U 1 M7 1 2 9 a THOMAS RD I---- L—!531 s a1 2a .� a WOLFE RD a AT7 Ti F a C o ANX2017-07015; Owner(s): Multiple Owners Case: ANX2017-08016; 14C ANX2017-08018 MERRILL. AVE 4.917 Site: Multiple Sites Size(Acres): D • 7 e S 4 3 2 70 tt 12 113 74 13 M 77 Atlas Page: 283A I 4 R 00t Exhibit B R PROPOSED ANNEXATION w Rev. GO W 7 ra 023 s Acp 1 1 I 33 1 34 1 35 1 1 1 1 1 1 SHIN AERNADINO I 1 32 1 31 30 17 1 13 11 1 S#N MATEO ST s 14 X13 �U 1 M7 1 2 9 a THOMAS RD I---- L—!531 s a1 2a .� a WOLFE RD a AT7 Ti F a C o ANX2017-07015; Owner(s): Multiple Owners Case: ANX2017-08016; 14C ANX2017-08018 MERRILL. AVE 4.917 Site: Multiple Sites Size(Acres): HO N � Nf a Land Use Zoning PIN: (See attached sheet) From: RL / Undesignated R-3 RL / Atlas Page: 283A TO: Water/Drainage LMDR 4 3 2 Exhibit B iin ?g10 IS 13 Is 7i 17 AVE HOYTMIX a �a R 1 I I A D B 7 4 3 2 PROPOSED ANNEXATION w Rev. GO W 7 ra 023 s Acp 1 1 I 33 1 34 1 35 1 1 1 1 1 1 SHIN AERNADINO I 1 32 1 31 30 17 1 13 11 1 S#N MATEO ST s 14 X13 �U 1 M7 1 2 9 a THOMAS RD I---- L—!531 s a1 2a .� a WOLFE RD a AT7 Ti F a C o ANX2017-07015; Owner(s): Multiple Owners Case: ANX2017-08016; ANX2017-08018 Property 4.917 Site: Multiple Sites Size(Acres): ROW (Acres): n/a Land Use Zoning PIN: (See attached sheet) From: RL / Undesignated R-3 RL / Atlas Page: 283A TO: Water/Drainage LMDR Feature Overlay Exhibit B ORDINANCE NO. 9070-17 AN ORDINANCE OF THE CITY OF CLEARWATER, FLORIDA, AMENDING THE FUTURE LAND USE ELEMENT OF THE COMPREHENSIVE PLAN OF THE CITY, TO DESIGNATE THE LAND USE FOR CERTAIN REAL PROPERTY LOCATED GENERALLY NORTH OF DREW STREET, SOUTH OF SR 590, AND WITHIN % MILE WEST OF MCMULLEN BOOTH ROAD, WHOSE POST OFFICE ADDRESSES ARE 901, 911, AND 917 GLEN OAK AVENUE EAST, 3025 AND 3061 GLEN OAK AVENUE NORTH, 3026 GRAND VIEW AVENUE, 3046 AND 3053 HOYT AVENUE, 3065 AND 3071 MERRILL AVENUE, 911 MOSS AVENUE, AND TWO UNADDRESSED PARCELS MORE APPROPRIATELY KNOWN AS LAKE LOUISE AND LAKE CAROL, ALL IN CLEARWATER, FLORIDA 33759, UPON ANNEXATION INTO THE CITY OF CLEARWATER, AS RESIDENTIAL LOW (RL) AND WATER DRAINAGE FEATURE OVERLAY; PROVIDING AN EFFECTIVE DATE. WHEREAS, the amendment to the Future Land Use Element of the Comprehensive Plan of the City as set forth in this ordinance is found to be reasonable, proper and appropriate, and is consistent with the City's Comprehensive Plan; now, therefore, BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CLEARWATER, FLORIDA: Section 1. The Future Land Use Element of the Comprehensive Plan of the City of Clearwater is amended by designating the land use category for the hereinafter described property, upon annexation into the City of Clearwater, as follows: Property Land Use Category See attached Exhibit A for Legal Residential Low Descriptions; (RL) and Water Drainage Feature Overlay (ANX2017-07015, ANX2017-08016, ANX2017-08018) The map attached as Exhibit B is hereby incorporated by reference. Section 2: The City Council does hereby certify that this ordinance is consistent with the City's Comprehensive Plan. Section 3. This ordinance shall take effect immediately upon adoption, contingent upon and subject to the adoption of Ordinance No. 9069-17. Ordinance No. 9070-17 PASSED ON FIRST READING PASSED ON SECOND AND FINAL READING AND ADOPTED uam110 A. 5010 Assistant City Attorney Nov 16 2017 Ordinance No. 9070-17 DEC 0 7 2017 —Ckw jt\CttWcof George N. Cretekos Mayor Attest: z VO Rosemarie Call City Clerk A�l4BllSNED Ordinance No. 9070-17 Exhibit A Address Legal Description No. Parcel ID. 901 Glen Oak Lot 8, Block C, KAPOK TERRACE, according to the plat Avenue East thereof, recorded in Plat Book 36, Pages 14 and 15, Public 09-29-16-45126-003-0080 Records of Pinellas County, Florida 911 Glen Oak Lot 10, Block C, KAPOK TERRACE SUBDIVISION, according Avenue East to the map or plat thereof as recorded in Plat Book 36, 09-29-16-45126-003-0100 page 14 of the Public Records of Pinellas County, Florida. 917 Glen Oak Lot 12, Block C, KAPOK TERRACE, according to the map or Avenue East plat thereof, as recorded in Plat Book 36, Pages 14-15, 09-29-16-45126-003-0120 Public Records of Pinellas County, Florida. 3025 Glen Oak Lot 7, Block E, KAPOK TERRACE, according to the plat Avenue North thereof, recorded in Plat Book 36, Page 14 and 15 of the 09-29-16-45126-005-0070 Public Records of Pinellas County, Florida. 3061 Glen Oak Lot 1, Block E, KAPOK TERRACE, according to Map or Plat Avenue North thereof as recorded in Plat Book 36, Pages 14 and 15, 09-26-16-45126-005-0010 Public Records of Pinellas County, Florida Unaddressed Grand View Kapok Terrace Subdivision Block G, Lake Louise and Park Avenue Area to west 09-29-16-45126-007-0140 (Lake Louise) 3026 Grand View Lot 9, Block G, KAPOK TERRACE SUBDIVISION, according to the plat thereof as recorded in Plat Book 36, Page 14, 09-29-16-45126-007-0090 Avenue Public Records of Pinellas County, Florida Lot 12, Block I, Kapok Terrace First Addition, according to 3046 Hoyt Avenue the map or plat thereof, as recorded in Plat Book 49, Pages 09-29-16-45144-009-0120 48, of the Public Records of Pinellas County, Florida. Lot 6, Block J, KAPOK TERRACE, FIRST ADDITION, according 3053 Hoyt Avenue to the map or plat thereof as recorded in Plat Book 49, 09-26-16-45144-010-0060 page 48, of the Public Records of Pinellas County, Florida. 3065 Merrill Lot 4, Block I, Kapok Terrace First Addition, according to Avenue the plat thereof, as recorded in Plat Book 49, Page 48, 09-29-16-45144009-0040 Public Records of Pinellas County, Florida Exhibit A Address Legal Description No. Parcel ID. 3071 Merrill Lot 3, Block I, KAPOK TERRACE FIRST ADDITION, according Avenue to the plat thereof, as recorded in Plat Book 49, Page 48, 09-29-16-45144-009-0030 Public Records of Pinellas County, Florida. Unaddressed Kapok Terrace Subdivision Block F, Lake Carol and Park Moss Avenue Area in northwest corner of Block 09-29-16-45126-006-0070 (Lake Carol) A portion of Lot 2, Block F, Kapok Terrace, as recorded in Plat Book 36, Page 14 and 15, of the Public Records of Pinellas County, Florida, more particularly described as follows: Commence at the Pt of tot 1 of said Block F, fronting on Moss Avenue (60' R.O.W.), thence S 01 degrees 07 minutes 32 seconds E, 49.98 feet to the Point of Beginning; thence continue S 01 degrees 07 minutes 32 seconds E, 39.18 feet along the 911 Moss Avenue Westerly right-of-way of said Moss Avenue to the PC of a curve 09-29-16-45126-006-0020 concave to the left, having a radius of 590 feet and a delta of 02 degrees 12 minutes 34 seconds, thence along said curve, 22.75 feet along said Moss right-of-way to a P.O.C.; thence S 85 degrees 36 minutes 30 seconds W, 133.56 feet; thence N 01 degrees 58 minutes 30 seconds W, 61.76 feet, thence N 85 degrees 27 minutes 50 seconds E, 134.45 feet to the said Westerly right-of-way of Moss Avenue, said point also being the point of beginning. 2s "op : ' .fid: •' S : r.'.:•:" M • 'M•• • t•f • W .':�' .15. i.i . 1�t1! • 12 A a GLEN OAK AVE N a to i RR OS 918 w �t j 1° Rev. 9/t =17 uICE � •�1• .•1.I. a •2 1 to � OL 2 911 907 0 1;. SEE F m .r •d• ;•Q. •. �..•y�:.�Lry. •: ;y e m afm Fi ��!! 'iaL T$y daj �Q1 9" .,M e • * :. LAKE VISTA DR a ' : 904 92t 5 Aco 12 Acpa CG e e e' ::. •� : J 999 CG 3 33 a TERRACE VIEW LN >: (14) '•� • . •. S1IN BERNADINO , LOUISE •Via. ' P. '.1: a : S• " 32 31 12 TV i5 ROS ,w a GRAND VIEW AVE a N MATEO ST :'': a :•,' a 88215 Q MERRIL . AVE a a THOMAS RD i Yom,' ' 1'a.; bid "16. OwNt , 04 20e ,, • :4i :�? g W Pd :'•; ;' 12 13 1wq q Owq WOLFE RD •f. HOYTA 7 � e � 9' 10� N .m FUTURE LAND USE MAP C ^Y ANX2017-07015; Owner(s): Multiple Owners Case: ANX2017-08016; :'': a :•,' a 88215 Q MERRIL . AVE a a THOMAS RD i Yom,' ' 1'a.; bid "16. OwNt , 04 20e ,, tie h g W a 88215 Q MERRIL . AVE a a THOMAS RD i Yom,' ' 1'a.; bid sti%r� .• 3 �-- Pd :'•; ;' 12 13 1wq q Owq WOLFE RD O HOYTA AO �OS 1.4 �/ o .m FUTURE LAND USE MAP ANX2017-07015; Owner(s): Multiple Owners Case: ANX2017-08016; ANX2017-08018 Property 4.917 Site: Multiple Sites S¢e(Acres): ROW (Acres): n/a Land Use Zoning PIN: (See attached sheet) From: RL / Undesignated R-3 RL / Atlas Page: 283A To: Water/Drainage LMDR Feature Overlay Exhibit B ORDINANCE NO. 9071 47 AN ORDINANCE OF THE CITY OF CLEARWATER, FLORIDA, AMENDING THE ZONING ATLAS OF THE CITY BY ZONING CERTAIN REAL PROPERTY LOCATED GENERALLY NORTH OF DREW STREET, SOUTH OF SR 590, AND WITHIN % MILE WEST OF MCMULLEN BOOTH ROAD, WHOSE POST OFFICE ADDRESSES ARE 901, 911, AND 917 GLEN OAK AVENUE EAST, 3025 AND 3061 GLEN OAK AVENUE NORTH, 3026 GRAND VIEW AVENUE, 3046 AND 3053 HOYT AVENUE, 3065 AND 3071 MERRILL AVENUE, 911 MOSS AVENUE, AND TWO UNADDRESSED PARCELS MORE APPROPRIATELY KNOWN AS LAKE LOUISE AND LAKE CAROL, ALL IN CLEARWATER, FLORIDA 33759, UPON ANNEXATION INTO THE CITY OF CLEARWATER, AS LOW MEDIUM DENSITY RESIDENTIAL (LMDR); PROVIDING AN EFFECTIVE DATE. WHEREAS, the assignment of a zoning classification as set forth in this ordinance is found to be reasonable, proper and appropriate, and is consistent with the City's Comprehensive Plan; now, therefore, BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY OF CLEARWATER, FLORIDA: Section 1. The following described property located in Pinellas County, Florida, is hereby zoned as indicated upon annexation into the City of Clearwater, and the Zoning Atlas of the City is amended, as follows: Property Zoning District See attached Exhibit A for Legal Low Medium Density Residential Descriptions; (LMDR) (ANX2017-07015, ANX2017-08016, ANX2017-08018) The map attached as Exhibit B is hereby incorporated by reference. Section 2. The City Engineer is directed to revise the Zoning Atlas of the City in accordance with the foregoing amendment. Section 3. This ordinance shall take effect immediately upon adoption, contingent upon and subject to the adoption of Ordinance No. 9069-17. Ordinance No. 9071-17 PASSED ON FIRST READING PASSED ON SECOND AND FINAL READING AND ADOPTED Assistant City Attomey Nov 1. .6 2017 DEC 0 7 1017 — Rwltftcr cis George N. Cretekos Mayor Attest: Rosemarie Call City Clerk Ordinance No. 9071-17 Exhibit A Address Legal Description No. Parcel ID. 901 Glen Oak Lot 8, Block C, KAPOK TERRACE, according to the plat Avenue East thereof, recorded in Plat Book 36, Pages 14 and 15, Public 09-29-16-45126-003-0080 Records of Pinellas County, Florida 911 Glen Oak Lot 10, Block C, KAPOK TERRACE SUBDIVISION, according Avenue East to the map or plat thereof as recorded in Plat Book 36, 09-29-16-45126-003-0100 page 14 of the Public Records of Pinellas County, Florida. 917 Glen Oak Lot 12, Block C, KAPOK TERRACE, according to the map or Avenue East plat thereof, as recorded in Plat Book 36, Pages 14-15, 09-29-16-45126-003-0120 Public Records of Pinellas County, Florida. 3025 Glen Oak Lot 7, Block E, KAPOK TERRACE, according to the plat Avenue North thereof, recorded in Plat Book 36, Page 14 and 15 of the 09-29-16-45126-005-0070 Public Records of Pinellas County, Florida. 3061 Glen Oak Lot 1, Block E, KAPOK TERRACE, according to Map or Plat Avenue North thereof as recorded in Plat Book 36, Pages 14 and 15, 09-26-16-45126-005-0010 Public Records of Pinellas County, Florida Unaddressed Grand View Kapok Terrace Subdivision Block G, Lake Louise and Park Avenue Area to west 09-29-16-45126-007-0140 (Lake Louise) 3026 Grand View Lot 9, Block G, KAPOK TERRACE SUBDIVISION, according to Avenue the plat thereof as recorded in Plat Book 36, Page 14, 09-29-16-45126-007-0090 Public Records of Pinellas County, Florida Lot 12, Block I, Kapok Terrace First Addition, according to 3046 Hoyt Avenue the map or plat thereof, as recorded in Plat Book 49, Pages 09-29-16-45144009-0120 48, of the Public Records of Pinellas County, Florida. Lot 6, Block J, KAPOK TERRACE, FIRST ADDITION, according 3053 Hoyt Avenue to the map or plat thereof as recorded in Plat Book 49, 09-26-16-45144-010-0060 page 48, of the Public Records of Pinellas County, Florida. 3065 Merrill Lot 4, Block I, Kapok Terrace First Addition, according to Avenue the plat thereof, as recorded in Plat Book 49, Page 48, 09-29-16-45144-009-0040 Public Records of Pinellas County, Florida Exhibit A Address Legal Description No. Parcel ID. 3071 Merrill Lot 3, Block I, KAPOK TERRACE FIRST ADDITION, according to the plat thereof, as recorded in Plat Book 49, Page 48, 09-29-16-45144-009-0030 Avenue Public Records of Pinellas County, Florida. Unaddressed Kapok Terrace Subdivision Block F, Lake Carol and Park Moss Avenue Area in northwest corner of Block 09-29-16-45126-006-0070 (Lake Carol) A portion of Lot 2, Block F, Kapok Terrace, as recorded in Plat Book 36, Page 14 and 15, of the Public Records of Pinellas County, Florida, more particularly described as follows: Commence at the Pt of Lot 1 of said Block F, fronting on Moss Avenue (60' R.O.W.), thence S 01 degrees 07 minutes 32 seconds E, 49.98 feet to the Point of Beginning; thence continue S 01 degrees 07 minutes 32 seconds E, 39.18 feet along the 911 Moss Avenue Westerly right-of-way of said Moss Avenue to the PC of a curve 09-29-16-45126-006-0020 concave to the left, having a radius of 590 feet and a delta of 02 degrees 12 minutes 34 seconds, thence along said curve, 22.75 feet along said Moss right-of-way to a P.O.C.; thence S 85 degrees 36 minutes 30 seconds W, 133.56 feet; thence N 01 degrees 58 minutes 30 seconds W, 61.76 feet, thence N 85 degrees 27 minutes 50 seconds E, 134.45 feet to the said Westerly right-of-way of Moss Avenue, said point also being the point of beginning. Exhibit B h �• � • : �' •'iP ' 1e,' ..t!' • K.• •V• �.� 61!3. D ///�� SIR a GLEN OAK AVE N ¢ Mr t 81a p N 'I LAICE Rev. 90=7 CAROL = 9070/I er Ell F O LAKE VISTA DR e Y d1�[ �: Y06 984 12 Aciq Q = e /'+ O 6• d01: Z 9 • � : ,�q. a ~I 33 ,s t s a TERRACE VIEW LN e 136 I ! Lou '��• •' .'/: ••""++ h." .y ',pi•, Z, �p 4• ' •Q I 'e• S • IrJ I OSIR 13 I , I ' , ,•. u 32 31 30 19 19 2 GRAND VIEW AVE 1qO. s wp ,per gyp. �• , 111gpppp j` ' _A' 3 ate. S#N NAM ST • r' t� 1 to O 11 '17.•; .,10� 71 •'72' . is '. ; N• • 1S .. '� gK •;O� � •tii. � i 9 kV h '� � .tbl• h •�• ••�' �• � ii eT1 ti r s eaz4s y NERRILL AVE a THOMAS RD :>. � 1 ' , �D2890�,. �'r.. • :.ts : 6+ f : 3 i 1— 3h • :'• HOYTA D 9 At. •. 0SA? 1.4 Acic, �vae ZONING MAP ANX2017-07015; Owner(s): Multiple Owners Case: ANX2017-M16; ANX20174)8018 Property 4.917 Site: Multiple Sites Size(Acres): ROW (Acres): n/a Land Use Zoning (See attached PIN: sheet) RL / From : R-3 Undesignated RL / Atlas Page: 283A To: Water/Drainage LMDR Feature Overlay Exhibit B Annexation Map Request Planner Name: Ellen Crandall Case Number: ANX2017-08016 Date Request Submitted: 8/9/17 Date Requested for: 8/23/17 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) Required Documents ® Legal Descripti (warranty deed survey) - to be hand delivered ® Map with Prop 'g ted ® EDR - no hard copies submitted - all, submission material is accessible through Accela Location & Right-of-Way Language (for Ordinance Title) Location: 1.658 acres located generally north of Drew Street, south of SR 590, and within 1/4 mile wester McMullen Booth Road. 0 Right-of-Way: [ENGINEERLNG INSERT ROW DESC PTION OR 'N/A H'E'RE PROVIDED LEGAL DESCRIPTION VERIFIED BY: 41 L" lq Thomas Mahony, PSM, og hic Technology Manager MAP NAME Owner(s): Multiple Owners, see attached sheet Case: ANX2017-08016 Property Site: Multiple Addresses, see attached sheet Size(Acres): ROW (Acres): Land Use Zoning PIN: Multiple PINS, see attached sheet From : RL R-3 To: RL LMDR Atlas Page: 283A D4058 M Patricia Moore 3061 Glen Oak Ave. N ' Clearwater, FL 33759 D AUG 0 1 2017 CANNING & DEV, E a oPiuheTERDEPT ,..::1•J.1 Y.. !� 1 . � �.Y 1 �. .! '..:•�, O • fy4 Y T Y •..W�rmN.v'yK.: 'W`�A.us FOR Patricia Moore ' 3061 Glen Oak Ave. N Clear%vater, FL 33759 n 151�1�llU5 !E JUL 0 6 1017 ..ANNING & DSVELOPMENY MPT TAMPA FL �7kX j�j to b, � *'O "�,w„r+" • w pSp FOREVER3016 ;»:.�``��-�� ::;✓=�,i !if:��i��Jl�l�11i,�,;itr.lid'fI'Iislf:!'i11'Jliili.l�ll�iJr►J�iri}1i CLEARWATER 5Wr.H1A.'MZZA ffU4'BAYTO MACK ........ PROPERTY OWNER (PER DEED): Pamela A. Furst Planning & Development Department Petition for Annexation Disclosure Statement MAILING ADDRESS: 3071 Merrill Avenue, Clearwater FL 33759 PHONE NUMBER: 236-0229 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 V 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: NAME: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? PARTIES INVOLVED — NAME: NAME: PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: STATE OF FLORIDA, COUNTY OF PINELLAS V 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 subsc ibed before me this day of �' //---------by �Gcmme P /Q Ao Y ru r54'---., who is personally known/has �y c. Produced as identification. Signature of property owner or representative r6CA/1 Notary pub c,�o•�",'•,, VICKI JO KOMEROSKA Notary Public - State of F My commission expires: t 's3 Commission i 9"R Signature of property owner or representative I "'';F My Comm. Expires Mar 4, Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 5 of 7 Revised 08.18.2016 Pinellas County Property Appr-=-,er Address Query Pinellas County Address Query Click on the 18 digit parcel number to see General Information. Click on the "X" to view the map or short legal description Page 1 of 1 Found matches by dropping units, street directionals, and street type. Records 1 through 1 of 1 [8:00 am Tuesday August 81 New Parcel Sub or Plat Advanced/Sales { OwnerAddress Search: Number Condo/PUD Book/Paye Criteria Boo] Property Parcel Ownership Property Map Subdivision/Condo Plat OR Book/Page Tax Sl Address Info Use Name Book/Page Dist Lf 3061 09 -29 - GLEN 16- MOORE, Single KAPOK OAK 45126- PATRICIA Family X TERRACE SUB 36/14 01636/0628 0 CTF AVE N 005- M Home 0010 New Search: Owner Address Parcel Number Sub or Condo ;' PUD Plat Book/Page Sale OR Bo( Change address of selected parcels Question/Cornment aboutthis page(6 P, c http://pcpao.org/query_address.php?Addr2=3061+glen+oak+drive&nR=25 8/8/2017 jiwlir .�. O. tv mw Pwt �*IOW#Wt. aw/ i iV laws of `. y rsfCbmaft 'lig i ,Ilk - +y .,wr •I s. �M.rwr./wwrr�••��i1M� r�. awiu M iwdt tw ad/ of ti....:.% Metsmu 46 Jadd pow me MA 1a'+sr. tss /I� irNA +W. Ntta�e, w�i MMS M tAt fnor q/ �7 n spewpill INICIA-1c c I , qf 00 boom&. 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