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ANX2017-12025�}NXo2.ol"7-laoas �b) miss iqvC r-- ICLEARWATER JBRIGHT AND BFAVI7F'UI.•8�1YTO BEACH X601 MOSS AVE ANX2017-12025 ANNEXATION Mario E. & Mary M Calleja Zoning: Atlas #: 283A ALL APPLICATIONS ARE TO_BE...F.ILLED 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): Mario E. and Mary M. Calleja MAILING ADDRESS: 601 Moss Avenue, Clearwater, FL 33759 PHONE_NUMBER:� q " �3T4 EMAIL: me /k, 01�v vat c< AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: 601 Moss Avenue, Clearwater 33759 PARCEL NUMBER(S): 09-29-16-45126-001-0100 LEGAL DESCRIPTION: Lot 10, Block A, 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 Ill J --�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): REQUESTED (CITY): ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): SITE AREA: 0.224 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residential square footage) Residential Low (RL) Residential Low (RL) R-3 Single Family Residential Low Medium Density Residential acres USE OF PROPERTY: Existing (currently on site): Single Family Proposed (new use, if any; plus existing if to remain): Single Family If residential use, is'unit(s) rental? BARE 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 orapplicatio7 4 SwnTtnd subscribed before m tis "[ day of ',►1 "lll'' DOROTA HORBAL �� by MY COMMISSION # FF 210455 ';,g•� EXPIRES: March t6, Ot9 1Ais pers ly known/has x,101 Il,�� produced as identification. Signat a of property owner or repres tative ' / otary public, A ��1/1 1 dlj'�4 My commission expires: Sign Lure of p perty owner or represents e Planning 81 Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 2 of 7 Revised 02/16 CJ�[--�7CLEARWATER 7 BRIGHT AND BEAtMFUI.• BAY TO BEACH Planning & Development Department Petition for Annexation Submittal Package Instructions & Checklist IN ADDITION TO THE COMPLETED ANNEXATION PETITION FORM, ALL PETITION FOR ANNEXATION PACKAGES SHALL INCLUDE A SUBMITTAL PACKAGE THAT INCLUDES THE FOLLOWING: ❑ Signed and sworn (notarized) disclosure of interest statement (form attached). ❑ If the property is not a platted lot of record, a current survey identifying the dimensions, area and location of the property having been prepared, signed and sealed by a land surveyor currently registered in the State of Florida within the most recent 12 months. ❑ If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plat, and/or engineering plans are required. City staff will review proposed plans to determine their compliance with the City's Community Development Code. ❑ Terms of a proposed Agreement to Annex, if any. ❑ If the proposed annexation requires a change in the land use classification and zoning category assigned to the property, a justification for such change must be submitted in writing. If the requested zoning is not consistent with the Future Land Use Map of the City of Clearwater Comprehensive Plan, the applicant will be required to file a companion application to amend the map. ❑ Proof of ownership (e.g., copy of deed, title insurance policy, or other instrument demonstrating ownership). ❑ If connection to city services is desired prior to the effective date of the annexation, applicant must provide notarized Petition for Annexation Supplemental Statement (form attached). ❑ If applicant is designating an agent/representative to work with City, applicant must provide notarized Affidavit to Authorize Agent/Representative (form attached). INFORMATION REQUIRED TO COMPLETE THE PETITION FOR ANNEXATION APPLICATION AND DATA SHEET CAN BE FOUND ON THE FOLLOWING DOCUMENTS AND/OR ONLINE AT THE FOLLOWING WEBSITES. IF THE APPLICANT IS UNCERTAIN WHERE TO LOCATE THIS INFORMATION OR NEEDS ADDITIONAL ASSISTANCE, PLEASE CONTACT THE PLANNING AND DEVELOPMENT DEPARTMENT, LONG RANGE PLANNING DIVISION AT 727-562-4567. ❑ PARCEL NUMBER (Parcel I.D. Number) can be found on the Warranty Deed. It can also be found by searching the Pinellas County Property Appraiser's Office website at www.pcpao.org (search database by address). ❑ LEGAL DESCRIPTION can be found on the Warranty Deed. It can also be found by viewing the property record online at the Pinellas County Property Appraiser's Office website at www.pcpao.org. ❑ FUTURE LAND USE PLAN DESIGNATION (COUNTY) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://gis.pinellascounty.org/public 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://Pis.pinellascounty.org/public eis/. ❑ ZONING DISTRICT (CITY) can be found by contacting the Planning and Development Department or viewing the City's Zoning Atlas, available online at exteis.myclearwater.com/Zoninp,. ❑ SITE AREA (ACRES) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://Ris.pinellascounty.org/public gis/. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 3 of 7 Revised 02/16 �--!� CLEA RWATER 7J BRIGHT AND BEAtMVUL• BAYTOBEACH KZ 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 81 Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 4 of 7 Revised 02116 ---'.",CLEARWATER BRIGHT AND BEAU77NL•BAYTO BETCH PROPERTY OWNER (PER DEED): MAILING ADDRESS: PHONE NUMBEW° `EMAIL? AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER'PERSON- S HAV] NG -ANY OI NAME: INTEREST IS: SPECIFIC INTEREST HELD: Mario E. and Mary M. Calleja 601 Moss Avenue. Clearwater, FL 33759 - - S1 A Planning & Development Department Petition for Annexation Disclosure Statement IN.IJKESUBJECT PROPERTY! /a - 1 DOE -§A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? CONTRACT IS: PARTIES INVOLVED — NAME: NAME: ARE THERE ANY OPTIONS TO PURCHASE -THE SUBJECT PROPERTY? PARTIES INVOLVED — NAME: NAME: L fE THERE ANR-TG- AGE OR -LIENS ON THE SUBJECT PROPERTY? PARTIES INVO``LVED — NAME: NAME: ,. YES NO PHONE NUMBER: PHONE NUMBER: YES PHONE NUMBER: PHONE NUMBER: _,Y\ YES NO NO PHONE NUMBER: `% 7 PHONE NUMBER: W'bt is 1-6wgo . 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 appli tca ion. Sworn jo and subscribed before me this day of '*a� :&;. DOROTA NORBAL O) I by MV COMMISSION # FF 210455 EXPIRES: M h 16, 2019 • .�.�►�. w i rsonally known/has i ° n�pvti B Thr. n61 N produced asidentification. Signatu a of property owner or rep r ntative Not ry public, 4 p,,A My commission expires: Signature ofl, operty 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 CLEARWATERPlanning & Development ?Dartment ewGB�im�.BAY,OB� Petition for Antion Affidavit to Authorize Aeent/Reprative 1. ProZio�E. auresof all property owners on deed —PRINT full names: MaIleja Mary M. Ca e- 2. That (I a\m/ a ) he 601 Mo SSYaVe e C 3. That this proper n Annexation in order owner(s) and record title holder(s) of the following d arwater, FL 33759 tltutes the property for which a request for (des/cr'b'� C�ive solid waste and sanitary sewer servicel 4. That the undersigned (hal appointed and (does/do) ap as (his/their) agent(s) to execute%necess or other 5. That this affidavit has been execue the 1f described property; 6. That site visits to the property arirep Y owner authorizes City representatives to visiotc 7. That (1/we), the undersigned authority, herfrbyjEl�tj7�th Yr . .,/ " . Av VIA, Property roperty: uest): Wments necessary to affect such petition; Clearwater, Florida to consider and act on the above resentatives in order to process this application and the raph the property described in this application; t the foregoing is true and correct. Property Owner Property Owner STATE OF FLORIDA, COUNTY OF PI S BEFORE MEYUNDD, AN OFFICER DULYCOMMISSIONED BY THE S OF THE STATE OF FLORIDA, ON THIS PERSONALLY APPEARED ard u.k9-�nh WHO , ING BEEN FIRST DULY SWORN V DEPOSED A, SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT _ AT HE/SHE SIGNED. DOROTA HORBAL �ksdq :tAz"" LEXPIRES: SSION # FF 210455 ` •' March 16, 2019 �-wNotary Public Signature yh,n�\��u Nadanal Notary Assn. Notary S I/ 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 JBRIGHT AND BEALMrUL• BAYTO BEACH PROPERTY OWNER (PER DEED): Mario E. and Mary M. Calleja MAILING ADDRESS: 601 Moss Avenue, Clearwater, FL 33759 CITY OF CLEARWATER CASE NUMBER: Planning & Development Department Petition for Annexation Supplemental Statement I/we, _Mario E. & Mary M. Calleja [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 applicaY�°,n. Swor to an subscribed before me this '"t day of o�`;t:�• DOROTA HORBAL MY COMMISSION # FF 210455 Q by EXPIRES: March 16, 2019 t VV�n��RRyy` •'%r°,�;;:�` 13nnde ruNationW, Assn. `� 1 who is personally know/has rt ? produced V' as identification. Signaturyglof property owner (individual c uthorized representative of corporation, partnershlo or other entity) � Notary public, vodx My commission expires: f✓� Signature of r,6 -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 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: $o 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: NONCONTIGUOUS (TYPE A ENCLAVE) PROPERTY OWNER (PER Ashley M. Larson DEED): MAILING ADDRESS: 3035 Grand View Avenue PHONE NUMBER: n 2.-O 6318 -OI b 3 EMAIL: ALarson10582gmail.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 3035 Grand View Avenue PROPERTY: PARCEL NUMBER(S): 09-29-16-45126-001-0090 LEGAL DESCRIPTION: Kapok Terrace Sub BLK A, LOT 9 _ SOLID WASTE/ CURRENT CITY SERVICES:,,SANITARY SEWER RECYCLING X WATER SOLID WASTE/ kE- QUESTED CITY SERVICES: X SANITARY SEWER X RECYCLING X 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 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: 0.22 SIZE OF DEVELOPMENT: Existing: 1 dwelling unit Proposed: n/a (e.g., number of units, hotel rooms or non- residential square footage) R-3 Low Medium Density Residential (LMDR) acres USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; plus existing if to remain): If residential use, is unit(s), 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 home n/a No YES NO I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the b t of my knowledge and authorize City representatives to visit and photograph the property described in this application. Sworn to and subscribed before me this 15 day of lw&g6l . 2b19.by who is personally known/has produced Y.i36as identification. Signature of'KWe6y own or representative 7 My commission expires:+ Signature of property owner or representative Notary Public - State of Florida My Comm. Expires Sep 19, 2017 Commission # FF 055828 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562.4567; Page 2 of 7 Revised 08.18.2016 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; Page 3 of 7 Revised 08.18.2016 Planning & Development Department Petition for Annexation Information for Applicants ATTENDANCE AT PUBLIC HEARINGS The applicant or applicant's representative is encouraged to attend City Council public hearings unless the annexation pertains to a property developed or to be developed with one single family dwelling. STANDARDS FOR ANNEXATION In determining whether to annex a property, the City shall consider the extent to which: ❑ The proposed annexation will impact public services (e.g., water, sewer, police, parks, etc.). ❑ The proposed annexation is consistent with the City of Clearwater Comprehensive Plan. ❑ The proposed annexation requires a change in the future land use and zoning classifications assigned to the property as well as the jurisdiction for said change. ❑ Existing or proposed development is consistent with City regulations. ❑ Terms of a proposed Annexation Agreement, if any, promotes the City of Clearwater Comprehensive Plan. PROPERTY OWNER AGREEMENT Please be advised that, in consideration of the annexation, the property owners do hereby agree that: ❑ All structures and improvements which are erected upon said property subsequent to the date of this petition for annexation shall comply with all applicable City of Clearwater regulations and ordinances as set forth in the City Community Development Code; ❑ All residential rental units, including single-family residences must comply with the requirements in the city's residential rental ordinance, which requires the property owner to obtain a Business Tax Receipt upon annexation into the city; ❑ If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plat, and engineering plans shall be submitted to ensure compliance with the city's Community Development Code (see Submittal Package Instructions Checklist). It is recommended that the applicant meet with Planning and Development Department staff to review plans and/or discuss the applicable city regulations; ❑ All annexations of residential dwellings of eight dwelling units or more shall convey such recreation facilities fees and recreation land dedication and/or fees in the amount and manner prescribed by Chapter 54, Article II of Clearwater Code of Ordinances; and ❑ When any substandard abutting street or utilities are subsequently upgraded by the City to meet City Standards, said improvement(s) will be done on an assessment basis, consistent with City procedures therefore. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 4 of 7 Revised 08.18.2016 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. 1 Sworn to and subscribed before me this 5 day of [!\kA Cru 'f) 1 20 V) . by who is personally known/has �t3 produced �� S Q na �1 0 41as identification. representative L11 Notary publibj gugso jj # uoissiwwuj My commission expires: / Inz 'A, rl,n �,,,,i, , Signature of property owner or representative ENJOIJ !o alels - ollgnd d,eloN J' Nn' "WAAWA Al Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-561-4697; Page 5 of 7 Revised 08.18.2016 Planning & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Ashley M. Larson MAILING ADDRESS: 3035 Grand View Avenue PHONE NUMBER: 072"1) lo38 —OI %3 EMAIL: ALarson1058@Rmail.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: , OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: NIA INTEREST IS: SPECIFIC INTEREST HELD: .DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? YES �_ NO CONTRACT IS: PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY?. YES _X NO PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? X YES NO PARTIES INVOLVED—NAME: Wous f'rmezo NOME meet rx#UF 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. 1 Sworn to and subscribed before me this 5 day of [!\kA Cru 'f) 1 20 V) . by who is personally known/has �t3 produced �� S Q na �1 0 41as identification. representative L11 Notary publibj gugso jj # uoissiwwuj My commission expires: / Inz 'A, rl,n �,,,,i, , Signature of property owner or representative ENJOIJ !o alels - ollgnd d,eloN J' Nn' "WAAWA Al Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-561-4697; Page 5 of 7 Revised 08.18.2016 Planning & Development Departm Petition for Annexa n Affidavit to Authorize Aizent/Renrese tive 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 pr ty: 3. That this property constitutes the property for which a request for (describe re st): 4. That the undersigned (has/have) appointed and (does/do) appoint: as (his/their) agent(s) to execute any petitions or other d 5. That this affidavit has been executed to induce the City described property; tints necessary to arrect sucn petition; earwater, Florida to consider and act on the above 6. That site visits to the property are necessary by C�&ph sentatives in order to process this application and the owner authorizes City representatives to visit and the property described in this application; 7. That (1/we), the undersigned authority, hereby, THIS Property Owner that the foregoing is true and correct. Property Owner Property Owner Property Owner STATE OF FLORIDA, COUNTY OF PINELLAS BEFORE ME THE UND IGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON DAY OF PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN DEPOSE4AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Public Signature Seal/Stamp My Commission Expires: Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 6 of 7 Revised 08.18.2016 Planning & Development Department Petition for Annexation Supplemental Statement PROPERTY OWNER (PER DEED): Ashley M. Larson MAILING ADDRESS: 3035 Grand View Avenue CITY OF CLEARWATER CASE NUMBER: I/we, Ashley M. Larson, 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. r '�f1j� Sworn to and subscribed before me this 1 J day of IN. ` u ��-�S`� t) J!�L. by who is personally known/has produced tSOi� c_,�� .. Y_taOli'nas identification. Signature of property owne (in ividual or authorized representative of corporation, ership or other �� entity) (;) , Notary public, My commission expire. Signature of co -property owner Notary Public - State of Florida Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 7 of 7 Revised 08.18.2016 Planning & Development Department Petition for Annexation ALL APPLICATIONS ARE TO BE FILLED OUT COMPLETELY AND CORRECTLY, AND SUBMITTED TO THE PLANNING & DEVELOPMENT DEPARTMENT BY NOON ON THE SCHEDULED DEADLINE DATE. ALL PAGES WITHIN MUST BE SIGNED BY ALL PROPERTY OWNERS LISTED ON THE DEED. ONE (1) COMPLETE SET (1 ORIGINAL APPLICATION AND SUPPLEMENTAL MATERIALS) AS REQUIRED WITHIN IS TO BE SUBMITTED FOR REVIEW BY THE DEVELOPMENT REVIEW COMMITTEE. IT IS INCUMBENT UPON THE APPLICANT TO SUBMIT COMPLETE AND CORRECT INFORMATION. ANY MISLEADING, DECEPTIVE, INCOMPLETE OR INCORRECT INFORMATION MAY INVALIDATE YOUR APPLICATION. THE APPLICANT, BY FILING THIS APPLICATION, AGREES TO COMPLY WITH ALL APPLICABLE REQUIREMENTS OF THE COMMUNITY DEVELOPMENT CODE. APPLICATION FEE: So 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 Ashley M. Larson DEED): MAILING ADDRESS: 3035 Grand View Avenue PHONE NUMBER: 639-0163 EMAIL: ALarson10582gmail.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: PARCEL NUMBERN: 3035 Grand View Avenue 09-29-16-45126-001-0090 LEGAL DESCRIPTION: Kapok Terrace Sub BLK A, LOT 9 SOLID WASTE/ CURRENT CITY SERVICES: SANITARY SEWER RECYCLING WATER SOLID WASTE/ REQUESTED CITY SERVICES: X SANITARY SEWER X RECYCLING X 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 e' & V A T E ( Planning & Development Department Petition for Annexation ALL APPLICATIONS ARE TO BE FILLED OUT COMPLETELY AND CORRECTLY, AND SUBMITTED TO THE PLANNING & DEVELOPMENT DEPARTMENT BY NOON ON THE SCHEDULED DEADLINE DATE. ALL PAGES WITHIN MUST BE SIGNED BY ALL PROPERTY OWNERS LISTED ON THE DEED. ONE (1) COMPLETE SET (1 ORIGINAL APPLICATION AND SUPPLEMENTAL MATERIALS) AS REQUIRED WITHIN IS TO BE SUBMITTED FOR REVIEW BY THE DEVELOPMENT REVIEW COMMITTEE. IT IS INCUMBENT UPON THE APPLICANT TO SUBMIT COMPLETE AND CORRECT INFORMATION. ANY MISLEADING, DECEPTIVE, INCOMPLETE OR INCORRECT INFORMATION MAY INVALIDATE YOUR APPLICATION. THE APPLICANT, BY FILING THIS APPLICATION, AGREES TO COMPLY WITH ALL APPLICABLE REQUIREMENTS OF THE COMMUNITY DEVELOPMENT CODE. APPLICATION FEE: $0 IMPACT FEE/ASSESSMENT FEE: TBD Information on Impact Fees orAssessment Fees is available from the City of Clearwater Engineering Department (562-4747). To Be Completed By City of Clearwater: TYPE OF ANNEXATION: X CONTIGUOUS NONCONTIGUOUS (TYPE A ENCLAVE) To Be Completed By Property Owner: PROPERTY OWNER (PER DEED): Jose A. Ramones MAILING ADDRESS: 3070 Merrill Avenue, Clearwater, FL 33759 PHONE NUMBER: 727-359-2833 EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 3070 Merrill Avenue, Clearwater 33759 PROPERTY: PARCEL NUMBER(S): 09-29-16-45126-001-0160 LEGAL DESCRIPTION: Lot 16, Block A, 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 8 Revised 02/16 . T i.^^F Ai:'7'ka ti:. ^ XiA"5' ],:1 MSO' Planning & Development Department Petition for Annexation Data Sheet PLEASE ENSURE THAT THE FOLLOWING INFORMATION IS FILLED OUT, IN ITS ENTIRETY. FAILURE TO COMPLETE THIS FORM WILL RESULT IN YOUR APPLICATION BEING FOUND INCOMPLETE AND POSSIBLY DEFERRED UNTIL THE FOLLOWING APPLICATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY) REQUESTED (CITY) ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): SITE AREA: 0.198 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residential square footage) Residential Low (RL) Residential Low (RL) R-3 Single Family Residential Low Medium Density Residential (LMDR) acres USE OF PROPERTY: Existing (currently on site) Proposed (new use, if any; plus existing if to remain): If residential use, is unit(s) rental? Single Family Single Family ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? YES ❑ NO X 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 Z� day of IV),So' 7a r 7 by O'OX--' 'OPgpA4 ^ p' 1 o is personally known/has produced J��L Ill.- JZ55-2 QW'I44U as identification. Signature of br&rwner or representative 55-2 a /V 52 WSJ Nott p llc, My commission expires: Signature of propeft.,(owner or representative Notary Public State of Florida My COMM136wn Fxplrea Ioil W2017 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 2 of 8 Revised 02/16 , aWA i MV-l£ ........_...... Planning & Development Department Petition for Annexation Submittal Package Instructions & Checklist IN ADDITION TO THE COMPLETED ANNEXATION PETITION FORM, ALL PETITION FOR ANNEXATION PACKAGES SHALL INCLUDE A SUBMITTAL PACKAGE THAT INCLUDES THE FOLLOWING: ❑ Signed and sworn (notarized) disclosure of interest statement (form attached). ❑ If the property is not a platted lot of record, a current survey identifying the dimensions, area and location of the property having been prepared, signed and sealed by a land surveyor currently registered in the State of Florida within the most recent 12 months. ❑ If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plat, and/or engineering plans are required. City staff will review proposed plans to determine their compliance with the City's Community Development Code. ❑ Terms of a proposed Agreement to Annex, if any. ❑ If the proposed annexation requires a change in the land use classification and zoning category assigned to the property, a justification for such change must be submitted in writing. If the requested zoning is not consistent with the Future Land Use Map of the City of Clearwater Comprehensive Plan, the applicant will be required to file a companion application to amend the map. ❑ Proof of ownership (e.g., copy of deed, title insurance policy, or other instrument demonstrating ownership). ❑ If connection to city services is desired prior to the effective date of the annexation, applicant must provide notarized Petition for Annexation Supplemental Statement (form attached). ❑ If applicant is designating an agent/representative to work with City, applicant must provide notarized Affidavit to Authorize Agent/Representative (form attached). INFORMATION REQUIRED TO COMPLETE THE PETITION FOR ANNEXATION APPLICATION AND DATA SHEET CAN BE FOUND ON THE FOLLOWING DOCUMENTS AND/OR ONLINE AT THE FOLLOWING WEBSITES. IF THE APPLICANT IS UNCERTAIN WHERE TO LOCATE THIS INFORMATION OR NEEDS ADDITIONAL ASSISTANCE, PLEASE CONTACT THE PLANNING AND DEVELOPMENT DEPARTMENT, LONG RANGE PLANNING DIVISION AT 727-562-4567. ❑ PARCEL NUMBER (Parcel I.D. Number) can be found on the Warranty Deed. It can also be found by searching the Pinellas County Property Appraiser's Office website at www.pcpao.org (search database by address). ❑ LEGAL DESCRIPTION can be found on the Warranty Deed. It can also be found by viewing the property record online at the Pinellas County Property Appraiser's Office website at www.pcpao.org. ❑ FUTURE LAND USE PLAN DESIGNATION (COUNTY) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://gis.pinellascounty.org/public gis/. Search by property address or Parcel I.D. Number and report will appear. ❑ FUTURE LAND USE PLAN DESIGNATION (CITY) is typically the same as the land use designation in Pinellas County, unless applicant is proposing a change (see submittal package requirements for more information). ❑ ZONING DISTRICT (COUNTY) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://gis.pinellascounty.org/public gis/. ❑ ZONING DISTRICT (CITY) can be found by contacting the Planning and Development Department or viewing the City's Zoning Atlas, available online at extgis.myclearwater.com/Zoning. ❑ SITE AREA (ACRES) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://gis.pinellascountV.org/public gis/. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 3 of 8 Revised 02116 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 8 Revised 02116 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 7A day of 'p -n 2A t" 1 . by 331(✓ 7ld Mj who is personally known/has rJ produced �;, VL STX'g4 21 "`��'y�''a as identification. Signatur� ro r�owner or representative Notary p li , per Notary Public,Stag of F100 My con sslon eXplres: James Wagner C,pa My ommission �FOFpd" Expires 10/15/2017 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Page 5 of 8 Revised 02116 Planning & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Jose A. Ramones MAILING ADDRESS: 3070 Merrill Avenue, Clearwater, FL 33759 PHONE NUMBER: 727-359-2833 EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? YES NO CONTRACT IS: PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? YES NO PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? %C 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 7A day of 'p -n 2A t" 1 . by 331(✓ 7ld Mj who is personally known/has rJ produced �;, VL STX'g4 21 "`��'y�''a as identification. Signatur� ro r�owner or representative Notary p li , per Notary Public,Stag of F100 My con sslon eXplres: James Wagner C,pa My ommission �FOFpd" Expires 10/15/2017 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Page 5 of 8 Revised 02116 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 6 of 8 Revised 02/16 gg('_' L gy gg Planning & Development Department - Petition for Annexation Affidavit to Authorize Agent/Representative 1. Provide names of all property owners on deed —PRINT full names: Jose A. Ramones 2. That (I am/we are) the owner(s) and record title holder(s) of the following described property: 3070 Merrill Avenue, Clearwater, FL 33759 3. That this property constitutes the property for which a request for (describe request): Annexation in order to receive solid waste and sanitary sewer service from the City. 4. That the undersigned (has/have) appointed and (does/do) appoint: as (his/their) agent(s) to execute any petitions or other documents necessary to affect such petition; 5. That this affidavit has been executed to induce the City of Clearwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by City representatives in order to process this application and the owner authorizes City representatives to visit and photograph the property described in this application; 7. That (1/we), the undersigned aut y, ereby certify that the foregoing is true and correct. Jose A. Ramones Propertyr 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 2g DAY OF *91 1- PERSONALLY APPEARED ' �9 572 42-1 8'i•—yZft_o 57S2 Dl03Y-0 WHO HAVING BEEN FIRST DULY SWORN DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Seal/Stamp No My Commission Expires: Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 7 of 8 Revised 02/16 Planning & Development Department "' Petition for Annexation Supplemental Statement PROPERTY OWNER (PER DEED): Jose A. Ramones MAILING ADDRESS: 3070 Merrill Avenue, Clearwater, FL 33759 CITY OF CLEARWATER CASE NUMBER: I/we, _Jose A. Ramones , l''i X') (t l W—U l YW I VZ& [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 -17 1; day of S15A_ 90i7 . by &MV�w �orye1 who is personally known/has produced 4�- DL as identification. Signature of prop(individual or authorized representativeo partnership or other entity) CD� Ilutdry i state o oru Notar pu ic, ?'�� James Wagner M mmission expires: �4o�a. EXuCes1011512o117046309 Signature of co -property owner ro_ Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865 Page 8 of 8 Revised 02116 67�-ICLEARWATER BRIGHT AND BEAUTIFUL• BAYTD 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: x CONTIGUOUS NONCONTIGUOUS (TYPE A ENCLAVE) To Be Completed By Property Owner: PROPERTY OWNER (PER DEED): Jonathan E. & Beatrice S. Steele MAILING ADDRESS: 3006 Lake Vista Drive, Clearwater, FL 33759 PHONE NUMBER: 727-504-2719 EMAIL: Bea.steele@gmail.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: 3006 Lake Vista Drive PARCEL NUMBER(S): 09-29-16-45126-006-0050 LEGAL DESCRIPTION: Kapok Terrace Sub Blk F, Lot 5 less a 1x16ft T/A on NE Cor and a strip on W side of Lot 4 SOLID WASTE/ CURRENT CITY SERVICES: SANITARY SEWER RECYCLING x WATER SOLID WASTE/ REQUESTED CITYSERVICES: 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 L--�CLEARWATER __-� , BRIGHT AND BEAUTIFUL• BAY TO BEACH Planning & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Jonathan E. & Beatrice S. Steele MAILING ADDRESS: 3006 Lake Vista Drive, Clearwater, FL 33759 PHONE NUMBER: 727-504-2719 EMAIL: Bea.steele@gmail.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: SONE 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 NO PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? YES NO PARTIES INVOLVED — NAME: AcRIEVA CKO(I ()N10Q PHONE NUMBER: 2Z7- t31— 7690 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. PaWciaA.Tucker Sworn to and subscribed before me this 1 --?q day of NOTARY PUBLIC by STATE OF FLORIDA / /� p L Comm#FF968MI � L tAI�JCG/7)1C�IY' 3 f_ je , who is personally known/has A XP / 1/2 produced r1 Cil',(jCZ d �." LCMY-P as identification. Signa re ol prope ty owner represe tive �0 Notary public, My commission expires: 4b 12o 2b Signature of pro erty 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 ..t�9CLEARWATER BlUGHT AND BEAUTUUL •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): REQUESTED (CITY): SITE AREA: 0.213 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): IIf residential use, is unit(s) trental? Single Family Single Family ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? YES ❑ NO r AL 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. paVidaA.TucW Sworn to and subscribed before me this -: day of NOTARY pUSUC STATE OF FLORIDA 200 . by Cwm* FF968631 it 12 JO �"i►X rl�� tel .� who is personally known/has produced FIDfidG1 Onxf U C-rt)S as identification. Signa of property owner or representative �— Notary public, My commission expires: 3J Z 1 ,� U2-� Signature of pr perty 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 02116 r-!ICLEARWATER BRIGHT MID BEAUTIFUL' BAYTO BEACH PROPERTY OWNER (PER DEED): Jonathan E. & Beatrice S. Steele Planning & Development Department Petition for Annexation Supplemental Statement MAILING ADDRESS: 3006 Lake Vista Drive, Clearwater, FL 33759 CITY OF CLEARWATER CASE NUMBER: I/we, _Jonathan E. & Beatrice S. Steele [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. PaWciaA.ucKer Sworn to and subscribed before me this day of NOTARY PUBLIC �� STATE OF FLORIDA aal � . by Comm# FF968631 / i Expires 3121 c� 20 Jona�k,rn �&Wol �Jf-t-eti , who is personally known/has produced F1Qr-i da 1 (- Ufil'- LCel"S-P as identification. Signaturf property owner (individual or authorized represe tive of corporation, partnership or other entity) Notary public, My commission expires: Signature-of—co-prop)erty 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 �-1CLEARWATER BRIGHT AND BEAUTTFUL• BAYTD 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: x CONTIGUOUS NONCONTIGUOUS (TYPE A ENCLAVE) To Be Completed By Property Owner: PROPERTY OWNER (PER DEED): Steele Family Trust, Jonathan E. & Beatrice S. Steele, Tre MAILING ADDRESS: 3006 Lake Vista Drive, Clearwater, FL 33759 PHONE NUMBER: 727-504-2719 EMAIL: Bea.steele@gmail.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 3007 Lake Vista Drive PROPERTY: PARCEL NUMBER(S): 09-29-16-45126-006-0 007 LEGAL DESCRIPTION: Kapok Terrace Sub Blk G, Lot 2 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 _ �CLEARWATER JBlUGHT AND BEAUTIFUL• BAYTO BFACH Planning & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Steele Family Trust, Jonathan E. & Beatrice S. Steele, Tre MAILING ADDRESS: 3006 Lake Vista Drive, Clearwater, FL 33759 PHONE NUMBER: 727-504-2719 EMAIL: Bea.steele@gmail.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: THER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: NAME: INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY?YES NO CONTRACT IS: PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? YES NO PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? 1 YES NO PARTIES INVOLVED — NAME: ACAIfY(p (f1�qQli (%.NiQ,'J PHONENUMBER: 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. PabiaiaA.Tucker Sworn to and subscribed before me this c2t9 day of NOTARY PUBLIC S(-i0�•�•�/ ) . by STATE OF FLORIDA Y C M*FF968631 "TAf)M zo ffC�1 who is personally known/has Owes �,Yl GG produced Fkn ,411 LICtr)t as identification. of property owner -or rep Notary public, My commission expires: 3 2/ I7oZ6 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 . ICLEARWATER BRIGHT AND BEAVIAFUL• BAY TO BEACH k 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: 0.242 acres SIZE OF DEVELOPMENT: Existing: 1 Proposed 1 (e.g., number of units, hotel rooms or non- residential square footage) USE OF PROPERTY: Existing (currently on site): Proposed (new use, if any; plus existing if to remain): �If residential use, is unit(s) trental? Single Family Single Family BARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? YES ❑ NC,2 IF YES, PLEASE LIST/EXPLAIN: STATE OF FLORIDA, COUNTY OF PINELLAS I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application. Sworn to and subscribed before me this Jq day of Patrice A Tucker by NOTARY PUBLIC STATE OF FLORIDA � C F968631 TPeje_ who is personally known/has y E 020produced O�lda ��X1d>iir' j(1°�!'K2. as identification. Sign Lure of proper y owne or rep entative TIL Notary public, s��My commission expires: A. ign of pr perty 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 C��ICLEARWATER . o 81UGHTMDBFAVIRM-1AYT0BFA0H Planning & Development Department Petition for Annexation Supplemental Statement PROPERTY OWNER (PER DEED): Steele Family Trust, Jonathan E. & Beatrice S. Steele, Tre MAILING ADDRESS: 3006 Lake Vista Drive, Clearwater, FL 33759 CITY OF CLEARWATER CASE NUMBER: I/we, _Jonathan E. & Beatrice S. Steele [insert names of all property owners], having filed a Petition for Annexation regarding the above property/case number, grant consent, agree and acknowledge that the City of Clearwater may immediately or at a later time process the application to completion, including adoption and recordation of related Ordinances, without the necessity to further notice me/us. This Supplemental Statement shall supersede any provision in any Agreement to Annex executed by me/us or my/our predecessors in interest. Select One Option Below Which Applies to This Petition for Annexation: ❑x Annexation of Contiguous Parcel(s): I/we further agree and acknowledge that I/we shall not rescind the Petition for Annexation or execute any documents attempting such rescission, and that any attempted rescission shall be of no force and effect. ❑ Annexation of Noncontiguous Parcel(s): I/we understand that this annexation is voluntary, and that I/we may withdraw this Petition for Annexation prior to final action on this Petition by the City of Clearwater. I/we further agree and acknowledge, however, that receipt of all sewer, solid waste or other city service is contingent upon completion of the Petition for Annexation process, and that any withdrawal of this Petition prior to final action by the City, may result in a discontinuance and termination of all City -provided services. STATE OF FLORIDA, COUNTY OF PINELLAS I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application. Pabicia A. Tucker Sworn to and subscribed before me this <:>141 day of NOTARY PUBLIC by STATE OF FLORIDA Conxn#FF (oS�TjL-e� e)'>°, who is personally known/has E res 3%� produced floc ��Ut� Lc C_t°Ai f_ as identification. of property owner VndividAl or authorized ative of corporation, partnership or other Signature of J Notary public, My commission expires: 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 Property Appraiser General Inf- __--iation Page 1 of 4 Interactive Map of thisap rcel Sales Query Back to QueKy Results New Search Tax Collector Home Page Contact Us EA 09-29-16-45126-006-0050 Compact Property Record Card Updated DecemberRadius Tax Estimator Email. Print 192017 Search Ownership/Mailing Address Chane Site Address Mailiny, Address Evacuation Zone STEELE, JONATHAN E SR Homestead: Y I Yes STEELE, BEATRICE S 3006 LAKE VISTA DR 3006 LAKE VISTA DR (Unincorporated) CLEARWATER FL 33759-3413 11 Historic: � No No Prope . Use: 0110 (Single Family Home) a?EMA/Wl_.M Living Units: 1 [click here to hide] Legal Description KAPOK TERRACE SUB BLK F, PT OF LOTS 4 & 5 DESC FR NE COR OF LOT 5 TH S65D01'41 "W 1 FT FOR POB TH CONT S65D01'41 "W 40.5FT TH SOOD 14'20"W 126FT TH CUR LT RAD 300FT ARC 90FT CB N81D17'34"E 89.66FT TH CUR LT RAD 300FT ARC 2FT CB N72D30'25"E 2FT TH N17D18'06"W 90.19FT TH N31D42'59"W 50.34FT TO POB Mortgage Letter E File for Homestead Exemption 2018 Parcel Use Exemption 2017 2018 Evacuation Zone Homestead: Y I Yes Homestead Use Percentage: 100.00% Government: No No on -Homestead Use Percentage: 0.00% Institutional: No No lassiiied Agricultural: No 11 Historic: � No No Parcel Information Latest Notice of Proposed Property Taxes (TRIM Notice} 19386/1219 $267,800 Sales 1[121030268181 D 36./14 Qr, IFue 2017 Interim Value Information Year Just/N4.arket Assessed Value/ C:outlty School. )Municipal. Value 501-1C 'I'axable Value Taxable Value 'Taxable Value 2017 $222,085 $133,393 $83,393 $108,393 $83,393 [click here to hide] Value History as Certified (yellow indicates correction on file) http://www.pcpao.org/general.php?strap=162909451260060050 12/1/2017 Evacuation Zone Most Recent Recording Sales Comparison Census Tract (NOT the same as a FEMA Plat Book/Page Flood Zone) 19386/1219 $267,800 Sales 1[121030268181 D 36./14 Qr, IFue 2017 Interim Value Information Year Just/N4.arket Assessed Value/ C:outlty School. )Municipal. Value 501-1C 'I'axable Value Taxable Value 'Taxable Value 2017 $222,085 $133,393 $83,393 $108,393 $83,393 [click here to hide] Value History as Certified (yellow indicates correction on file) http://www.pcpao.org/general.php?strap=162909451260060050 12/1/2017 Property Appraiser General Inf ation Page 1 of 4 Interactive Map of thisap rcel Sales Qum, Back to Query Results New Search Tax Collector Home Pace Contact Us WM 09-29-16-45126-007-0020 Compact Property Record Card Updated November Radius T'ax Estimator Email Print 3092017 Search Ownership/Mailing Address Change Mailin2 Address Site Address STEELE FAMILY TRUST Evacuation Zone STEELE, JONATHAN E SR TRE 3007 LAKE VISTA DR STEELE, BEATRICE S TRE (Unincorporated) 3006 LAKE VISTA DR Plat CLEARWATER FL 33759-3413 Sales Comparison Property Use: 0110 (Single Family Home) [click here to hide] Legal Description KAPOK TERRACE SUB BLK G, LOT 2 M:ort2a2e Letter ® File for Homestead W_,.._. 4:.._ Exemption 2017 2018 Homestead: No No Government: No No Institutional: No No Historic: No No 2018 Parcel Use FEMA/W LM Living Units: 1 Pomestead Use Percentage: 0.00% on -Homestead Use Percentap-e: 100.00% . No Parcel Information Latest Notice of :Proposed :Property Taxes (TRIM Notice) 19386/1216 ® $193,800 Sales 121030268181 D 36/14 Query 2017 Interim Value Information Year Just/Market Assessed Valuer County School Municipal Value SOH Can Taxable Value Taxable Value Taxable Value 2017 $162,480 $162,480 $162,480 $162,480 $162,480 [click here to hide] Value History as Certified (yellow indicates correction on file) Year Honivstead Jttst/l.I rket t:;xejiytion Value County Taxable Value Municipal Taxable Value http://www.pcpao.org/general.php?strap=162909451260070020 11/30/2017 Evacuation Zone Most Recent Plat Recording Sales Comparison Census Tract SNOT the same as a FEMA Book/Page Flood Zone) 19386/1216 ® $193,800 Sales 121030268181 D 36/14 Query 2017 Interim Value Information Year Just/Market Assessed Valuer County School Municipal Value SOH Can Taxable Value Taxable Value Taxable Value 2017 $162,480 $162,480 $162,480 $162,480 $162,480 [click here to hide] Value History as Certified (yellow indicates correction on file) Year Honivstead Jttst/l.I rket t:;xejiytion Value County Taxable Value Municipal Taxable Value http://www.pcpao.org/general.php?strap=162909451260070020 11/30/2017 act d bq o a _pbs� ti � �CLEARWATER t / RHIGHi.W�SFAfTiffUL•IfAYAV 9GCH /J 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) ,CURREt:T Cii i SERVi'CES: REQUESTED CITY SERVICES:: ((select all that 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 1 of 7 Revised 08.18.2016 To Be Completed By Property Owner: PROPERTY OWNER (PER DEED): Diane Turscak, Shirley Streebel MAILING ADDRESS: 675 14th Ave S, Safety Harbor FL 34695 ;PHONE NUMBER: S - 113 S 0 EMAIL: DIANETU RSCAK@YAHOO.COM AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY 807 Glen Oak Avenue F PARCEL NUMBER(S): 09-29-16-45126-003-0050 LEGAL DESCRIPTION: KAPOK TERRACE SUB BLK C, LOT 5 ,CURREt:T Cii i SERVi'CES: REQUESTED CITY SERVICES:: ((select all that 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 1 of 7 Revised 08.18.2016 '�CLEARWATER Planning & Development Department Petition for Annexation Data Sheet PLEASE ENSURE THAT THE FOLLOWING INFORMATION IS FILLED OUT, IN ITS ENTIRETY. FAILURE TO COMPLETE THIS FORM WILL RESULT IN YOUR APPLICATION BEING FOUND INCOMPLETE AND POSSIBLY DEFERRED UNTIL THE FOLLOWING APPLICATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY): Residential Low (RL) REQUESTED (CITY): Residential Low (RL) ZONING DISTRICT PRESENT (COUNTY): R-3 REQUESTED (CITY): Low Medium Density Residential (LMDR) SITE AREA: 0.19 SIZE OF DEVELOPMENT: Existing: 1 Proposed: n/a (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) trental? ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? IF YES, PLEASE LIST/EXPLAIN: Single family home ,.,\ e-5 YES ❑ NO STATE OF FLORIDA, COUNTY OF PINELLAS I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application. Sworn to and subscribed before me this LC11 day of q--> IA . b --- c---- who Q— produced known/hasas identification. Signature of property owner or representative pu"" SHANNON E WILSON Commission#0G124997 Notary public, * Expires September 11, 2021^� 2� +y. °to ��t�gudgetNutary$erv'� My commission expires: Signature of property owner $r representative Planning & Development UdpartrPrerit, 700 S. Myftla AVOUe, Clearwater, FL 33756, Tel: 727-562-4567; Page 2 of 7 Revised 08.18.2016 CLEARWATER • { FRIGHT AND 6tAITltFVI,•MY71�Yf6AC7i PROPERTY OWNER (PER DEED): Diane Turscak, Shirley Streebel Planning & Development Department Petition for Annexation Disclosure Statement MAILING ADDRESS: 675 141h Ave S, Safety Harbor FL 34695 PHONE NUMBER: EMAIL: dianeturscak@yahoo.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS HAVING_ ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY: N O ' NAME: INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? YES ✓ NO CONTRACT IS: PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? YES ✓ NO PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY? YES NO PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: STATE OF FLORIDA, COUNTY OF PINELLAS I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application. Sworn to and subscribed before me this Z 1 day of �s�p=ersonal ywho known/has �C.\y ✓5�-� produced as identification. Signature of property owner or representative { J ,.dqS"Wt40NE"LSON Notary public, JPu� �mmission#0G 1141 My commission expires: ��'f planning $ Development Department, 100 S. Myrtle Avenue, Clearwater, FL 83756, Tel: 727-362-4567; Page 5 of 7 Revised 08.18.2016 i ( .BUREAU of VITAL STATISTICS ` CERTIFICATION OF DEATH - STATE FILE NUMBER: 2014099533 DATE ISSUED: July 18, 2014 DECEDENT INFORMATION STATE FILE DATE: July 17, 2014 DAME: SHIRLEY STREEBEL AKA: SHIRLEY ROBERTS . DATE OF DEATH: July 16, 2014 SEX: FEMALE AGE: 090 YEARS DATE OF BIRTH: October 27, 1923 SSN: 365-22-7829 BIRTHPLACE: NILES (TOWNSHIP), MICHIGAN, UNITED STATES PLACE WHERE DEATH OCCURRED: HOSPICE FACILITY NAME OR STREET ADDRESS: Suncoast Hospice Care Center North Pinellas LOCATION OF DEATH: Palm Harbor, PINELLAS .COUNTY, 34684 SURVIVING SPOUSE, DECEDENT'S RESIDENCE AND HISTORY INFORMATION MARITAL STATUS: DIVORCED SPOUSE (IF FEMALE, MAIDEN NAME) -.NONE RESIDENCE: 807 GLEN OAK AVENUE EAST, CLEARWATER, FLORIDA 33759, UNITED STATES COUNTY: PINELLAS OCCUPATION, INDUSTRY: ARTIST, PAINTING RACE: X White -,,,;,;Slack or African Aynbdcan Asian Indian _Chinese w Filipino _Native Hawaiian —American Indian or Alaskan Native --Tribe: _Japanese _Korean _Vietnamese _Guamian or Chamorro _Samoan _Other Pacific ist _Other Asian: „Other: Unknown HISPANIC OR HAITIAN ORIGIN? NO, NOT OF HISPANIC/HAITIAN ORIGIN EDUCATION: SOME COLLEGE CREDIT, BUT NO DEGREE EVER IN U.S. ARMED FORCES?NO PARENTS AND INFORMANT INFORMATION FATHER: GEORGE ROBERTS MOTHER: EMILIE STRAITS INFORMANT: DIANE TURSCAK RELATIONSHIP TO DECEDENT: DAUGHTER INFORMANT'S ADDRESS:"67514TH AVENUE SOUTH, SAFETY HARBOR; FLORIDA 34695, UNITED STATES PLACE OF DISPOSITION AND FUNERAL FACILITY INFORMATION PLACE OF DISPOSITION: GEE AND SORENSEN CREMATORY SERVICES ST PETERSBURG, FLORIDA METHOD OF DISPOSITION: CREMATION FUNERAL DIRECTOR/LICENSE NUMBER: DAREN A. STERNAD, F042271 FUNERAL'FACILITY: SUNSET POINT FUNERAL HOME F062913 2689 -SUNSET POINT ROAD, CLEARWATER, FLORIDA 33759 CERTIFIER INFORMATION TYPE OF CERTIFIER: ASSOCIATE MEDICAL EXAMINER MEDICAL EXAMINER CASE NUMBER: 140601000 TIME OF DEATH (24 hr): 0550 CERTIFIER'S NAME: WAYNE DANIEL KURZ CERTIFIER'S LICENSE NUMBER: ME96874 NAME OF ATTENDING PHYSICIAN (If other than CI'itifler): NOT ENTERED State Registrar REQ: ' 2015069454 THE ABOVE SIGNATURE CERTIFIES THA THis IS'A 1 RUE AND CORRECT COPY OF THE OFFICIAL RECORD ON FILE IN THIS OFFICE. CHE sT+lTHIS DOCUMENT IS PRINTED OR PHOTOCOPIEp;ON SECURITY PAPER WITH WATERMARKS OF THE GREAT TF WARNING: SEAL OF THE STATE OF FLORIDA. DO NOT ACCEPT WITHOUT VERIFYING THE PRESENCE OF THE WATER- MARKS. THE DOCUMENT FACE CONTAINS A"MULTICOLORED BACKGROUND, GOLQ;IMBOSSED SEAL, AND THERMOCHROMIC FL. THE BACK CONTAINS,S� EGiAL LINES WITH TEXT. THE DOCUMENTWILL NOT PRODUCE, } A COLOR COPY. .. _ m DH FORM 1946 (03-13) �� 1I{I 'd b gA�6k i I III III�I •III' e 3 0 6 4 5 6 7 6� 1CLEARWATER JARIGHT V0JW.ATmPjL-my To UAGH PROPERTY OWNER (PER DEED): Diane Turscak, Shirley Streebel MAILING ADDRESS: 675 14th Ave S, Safety Harbor FL 34695 CITY OF CLEARWATER CASE NUMBER: Planning & Development Department Petition for Annexation Supplemental Statement I/we, Diane Turscak , 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 �� day of 7� (1 by N � �1%� �c._.�_ who is personally _ - ( known/has V /j produced as identification. Signature of property owner (individual or authorized representative of corporation, partnership or other entity) SHPJdNDnF 124 9'Notary public, +. ` rpmmissi° GG g 2021My commission expires: Signature of co -property own r��,< yetN'tosa. O h t-_ 2f Planning & DeVelopmsnt Department, 100 S, Myrtle Avenue, Clearnater, FL 33750, Tel: 727462-4587; Page 7 of 7 Revised 08.18.2016 Planning & Development Depart ent �CLEARWATER Petition for Annex ion Affidavit to Authorize Agent/Represe ative 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 pr erty: 3. That this property constitutes the property for which a request for (describe reqst): 4. That the undersigned (has/have) appointed and (does/do) appoint: as (his/their) agent(s) to execute any petitions or other docume s necessary to affect such petition; 5. That this affidavit has been executed to induce the City of Cl arwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by City rep esentatives in order to process this application and the owner authorizes City representatives to visit and pho graph the property described in this application; 7. That (1/we), the undersigned authority, hereby cer ' that the foregoing is true and correct. Property Owner Property Owner Property Owner Property Owner STATE OF FLORIDA, COUNTY OF PINELLAS BEFORE ME THE UNDERSIG D, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON THIS DAY F , PERSONALLY APPEAR ED WHO HAVING BEEN FIRST DULY SWORN //Stamp THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Public Signature Notary My Commission Expires: Planning & Development Department, 100 S. Myrtle Av2'ttud, Clearwater, FL 33756, Tel: 727-562-4567; Page 6 of 7 Revised 08.18.2016 ..BRIGHT AM 9LVjT* IL• HEY 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: X CONTIGUOUS NONCONTIGUOUS (TYPE A ENCLAVE) To Be Completed By Property Owner: PROPERTY OWNER (PER DEED): Hieu Tran MAILING ADDRESS: 3030 Hoyt Avenue __........ _. PHONE NUMBER: 'EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT 3030 Hoyt Avenue PROPERTY: PARCEL NUMBER(S): 09-29-16-45144-015-0020 LEGAL DESCRIPTION: KAPOK TERRACE 1 ST ADD BLK O, LOT 2 CURRENT CJTYSERVICES REQUESTED C`ITYSE-#-V S:. m select it that apPlyl SANITARY SEWER SANITARY SEWER SOLID WASTE/ RECYCLING SOLID WASTE/ RECYCLING WATER WATER Planning & Development Department, 06 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 1 of 7 Revised 08.18.2016 CLEARWATER IIR}GtiT AbtD HEAtfYrFr.2 li.iYTD HFAC}t Planning & Development Department Petition for Annexation Data Sheet PLEASE ENSURE THAT THE FOLLOWING INFORMATION IS FILLED OUT, IN ITS ENTIRETY. FAILURE TO COMPLETE THIS FORM WILL RESULT IN YOUR APPLICATION BEING FOUND INCOMPLETE AND POSSIBLY DEFERRED UNTIL THE FOLLOWING APPLICATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY) REQUESTED (CITY) ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): SITE AREA: 0.21 SIZE OF DEVELOPMENT: Existing: 1 Proposed: 1 (e.g., number of units, hotel rooms or non- residential square footage) Residential Low (RL) Residential Low (RL) R-4 Low Medium Density Residential (LMDR) acres USE OF PROPERTY: Existing (currently on site): Single Family House Proposed (new use, if any; plus existing if to remain): Single Family House If residential use, is unrt(s) rental? !� ARETHERE AIY 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 toand subscribed before me this 10, day of D-C`o 6p— R --:;�O(-,L— • by t� I Q L,l- Vi V1 �) T Ln , who is personally known/has ""'4p produced 'kt T DSa -0 as identification. of property owner or representative Notary public, My commission expires: Signature of property owner or representative BRENDA FONTANE UoV A\\1' • _ Commission H GG 141752 My Comm. Expires Sep 6, 2021 Bonded through National Notary Ass, Plihi'iing & Development Department, 100 6. Myrtle Avenue, Clearwater, RL 33736, Tel' 727-562-4567; Page 2 of 7 Revised 08.18.2016 CLEARWATER Planning & Development Department Petition for Annexation Submittal Package Instructions & Checklist IN ADDITION TO THE COMPLETED ANNEXATION PETITION FORM, ALL PETITION FOR ANNEXATION PACKAGES SHALL INCLUDE A SUBMITTAL PACKAGE THAT INCLUDES THE FOLLOWING: ❑ Signed and sworn (notarized) disclosure of interest statement (form attached). ❑ If the property is not a platted lot of record, a current survey identifying the dimensions, area and location of the property having been prepared, signed and sealed by a land surveyor currently registered in the State of Florida within the most recent 12 months. ❑ If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of the annexation, requisite site plans, plat, and/or engineering plans are required. City staff will review proposed plans to determine their compliance with the City's Community Development Code. ❑ Terms of a proposed Agreement to Annex, if any. ❑ If the proposed annexation requires a change in the land use classification and zoning category assigned to the property, a justification for such change must be submitted in writing. If the requested zoning is not consistent with the Future Land Use Map of the City of Clearwater Comprehensive Plan, the applicant will be required to file a companion application to amend the map. ❑ Proof of ownership (e.g., copy of deed, title insurance policy, or other instrument demonstrating ownership). ❑ If connection to city services is desired prior to the effective date of the annexation, applicant must provide notarized Petition for Annexation Supplemental Statement (form attached). ❑ If applicant is designating an agent/representative to work with City, applicant must provide notarized Affidavit to Authorize Agent/Representative (form attached). INFORMATION REQUIRED TO COMPLETE THE PETITION FOR ANNEXATION APPLICATION AND DATA SHEET CAN BE FOUND ON THE FOLLOWING DOCUMENTS AND/OR ONLINE AT THE FOLLOWING WEBSITES. IF THE APPLICANT IS UNCERTAIN WHERE TO LOCATE THIS INFORMATION OR NEEDS ADDITIONAL ASSISTANCE, PLEASE CONTACT THE PLANNING AND DEVELOPMENT DEPARTMENT, LONG RANGE PLANNING DIVISION AT 727-562-4567. ❑ PARCEL NUMBER (Parcel I.D. Number) can be found on the Warranty Deed. It can also be found by searching the Pinellas County Property Appraiser's Office website at www.pcpao.org (search database by address). ❑ LEGAL DESCRIPTION can be found on the Warranty Deed. It can also be found by viewing the property record online at the Pinellas County Property Appraiser's Office website at www.pcpao.org. ❑ FUTURE LAND USE PLAN DESIGNATION (COUNTY) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://gis.pinellascounty.org/public gis/. Search by property address or Parcel I.D. Number and report will appear. ❑ FUTURE LAND USE PLAN DESIGNATION (CITY) is typically the same as the land use designation in Pinellas County, unless applicant is proposing a change (see submittal package requirements for more information). ❑ ZONING DISTRICT (COUNTY) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http:/Igis.pinellascounty.org/public gis/. ❑ ZONING DISTRICT (CITY) can be found by contacting the Planning and Development Department or viewing the City's Zoning Atlas, available online at extgis.myclearwater.com/Zoning. ❑ SITE AREA (ACRES) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online at http://gis.pinellascounty.org/public gis/. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 3 of 7 Revised 08.18.2016 CLEARWATER &qIGW.%KD MACH 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 11 of Clearwater Code of Ordinances; and ❑ When any substandard abutting street or utilities are subsequently upgraded by the City to meet City Standards, said improvement(s) will be done on an assessment basis, consistent with City procedures therefore. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 4 of 7 Revised 08.18.2016 „��-r� ,��•� Planning & Development Department Petition for Annexation Disclosure Statement PROPERTY OWNER (PER DEED): Hieu Tran MAILING ADDRESS: 3030 Hoyt Avenue PHONE NUMBER: EMAIL: AGENT OR REPRESENTATIVE: N/A MAILING ADDRESS: PHONE NUMBER: EMAIL: OTWER PERSONS HAVING ANY OWNERSHIP INTEREST 1N THE SUBJECT PROPERTY:_ Q_ NAME: INTEREST IS: SPECIFIC INTEREST HELD: NO ©6- E -i CONTRACT EXIST -FOR SALE OF THE SUBJECT PROPERTY? YES 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: ARETHERE'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 I9 day of QJo6e2 ,a10 I+ by 1� 1 Qtr vin Tavl who is personally known/has producedT(ASO -?;?:� a - DSD- 3s identification. of pro#dfrty owner or representative 1-1 �- C-) Q— f Notary public, ; My commission expires: BRENDAFCINTANE .o �,�: yP��V,lir-St;,tFnfFlorida Signature of property owner or representative ' • ; J •= Commission# GG 141752 My Comm. Expires Sep 6, 2021 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 5 of 7 Revised 08.18.2016 A CLEARWATER <, �,�.nA-W�,II„Y,�.I, Planning &Development Depart ent Petition for Annex ion Affidavit to Authorize Agent/Represe ative 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 /erty: 3. That this property constitutes the property for which a request for (describe req t): 4. That the undersigned (has/have) appointed and (does/do) appoint: as (his/their) agent(s) to execute any p/certihat her documen necessary to affect such petition; 5. That this affidavit has been executed tCity of Cle ater, Florida to consider and act on the above described property; 6. That site visits to the property are necey repr entatives in order to process this application and the owner authorizes City representatives toto aph the property described in this application; 7. That (1/we), the undersigned authority, hat the foregoing is true and correct. Property OwnerProperty Owner 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 DEPOSED AND SA Notary Sea DAY OF/ , PERSONALLY APPEARED WHO HAVING BEEN FIRST DULY SWORN T HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Public Signature My Commission Expires: Planning & DOVelbpment Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 6 of 7 Revised 08.18.2016 CLEARWATER PROPERTY OWNER (PER DEED): MAILING ADDRESS: CITY OF CLEARWATER CASE NUMBER: Hieu Tran 3030 Hovt Avenue Planning & Development Department Petition for Annexation Sunnlemental Statement I/we, Hieu Tran, 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 [/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 au orize City representatives to visit and photograph the property described in this application. Sworn to and subscribed before me this 1 Q day of 11A O�bO- 0 ` aD (*- . by ' (2U, Vjy4l who is personally known/has produced '�� TLoSD- 3"38-713'0Sabas identification. )perty owner (individual or authorized of corporation, partnership or other entity) Notary public, My commission expires: Signature of co -property owner Mary Public - State of Florida Commission # GG 141752 Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Page 7 of 7 Revised 08.18.2016 rl-ICLEARWATER / BRIGHT AND BEAUTIFUL- BAYTO BEACH Planning & Development Department Petition for Annexation ALL APPLICATIONS ARE TO BE FILLED OUT COMPLETELY AND CORRECTLY, AND SUBMITTED TO THE PLANNING & DEVELOPMENT DEPARTMENT BY NOON ON THE SCHEDULED DEADLINE DATE. ALL PAGES WITHIN MUST BE SIGNED BY ALL PROPERTY OWNERS LISTED ON THE DEED. ONE (1) COMPLETE SET (1 ORIGINAL APPLICATION AND SUPPLEMENTAL MATERIALS) AS REQUIRED WITHIN IS TO BE SUBMITTED FOR REVIEW BY THE DEVELOPMENT REVIEW COMMITTEE. IT IS INCUMBENT UPON THE APPLICANT TO SUBMIT COMPLETE AND CORRECT INFORMATION. ANY MISLEADING, DECEPTIVE, INCOMPLETE OR INCORRECT INFORMATION MAY INVALIDATE YOUR APPLICATION. THE APPLICANT, BY FILING THIS APPLICATION, AGREES TO COMPLY WITH ALL APPLICABLE REQUIREMENTS OF THE COMMUNITY DEVELOPMENT CODE. APPLICATION FEE: $0 IMPACT FEE/ASSESSMENT FEE: TBD Information on Impact Fees or Assessment Fees is available from the City of Clearwater Engineering Department (562-4747). To Be Completed By City of Clearwater: TYPE OF ANNEXATION: X CONTIGUOUS NONCONTIGUOUS (TYPE A ENCLAVE) To Be Completed By Property Owner: PROPERTY OWNER (PER DEED): Brian Flaherty MAILING ADDRESS: ' '" V PHONE NUMBER: 727-94n-9sn? EMAIL: AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: ADDRESS OF SUBJECT PROPERTY: PARCEL NUMBER(S): LEGAL DESCRIPTION: CURRENT CITY SERVICES: Bflahertyl@msn.com 3065 Hoyt Avenue 09-29-16-45144-010-0040 G KAPOK TERRACE 1 ST ADD BLK J. LOT 4 SOLID WASTE/ SANITARY SEWER RECYCLING WATER SOLID WASTE/ REQUESTED CITYSERVICES' SANITARY SEWER RECYCLING WATER (select all that apply) Dlanninn R navalnnmam nanor4man4 1nA C Mvr41a Avenue riatsnv24ar 01 447Cf Tel• 797_RR9.d5R7- 6) .\ CLEARWATER Planning & Development Department Petition for Annexation Data Sheet PLEASE ENSURE THAT THE FOLLOWING INFORMATION IS FILLED OUT, IN ITS ENTIRETY. FAILURE TO COMPLETE THIS FORM WILL RESULT IN YOUR APPLICATION BEING FOUND INCOMPLETE AND POSSIBLY DEFERRED UNTIL THE FOLLOWING APPLICATION CYCLE. FUTURE LAND USE PLAN DESIGNATION PRESENT (COUNTY) REQUESTED (CITY) ZONING DISTRICT PRESENT (COUNTY): REQUESTED (CITY): SITE AREA: 0.19 SIZE OF DEVELOPMENT: Existing: 1 Proposed: n/a (e.g., number of units, hotel rooms or non- residential square footage) Residential Low Residential Low R-4 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 home N/A ply vl44i 1 R/3-0 e,4 Ivo 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 I/ day of n .en be e- 0 % _..by &,Lg n Q A -e h who is personally known/has produced %L h as identification. re of property o*rre tarrepresentative Notary publif O My comr, ion expires: Signature of property owner or representative MYRAJAMES Public - State of My Comm. Expires Mar 28, 201 Bonded through National Notary A n. Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; r— �CLEARWATER ` � BRIGH? AND BEAUTIRIL• BAY TO 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. P Proof of oyvner (e.g., copy of cjeel, l ii:le ip.sprance policy, or other instrument Jemonstrat�ng gwnership). ❑ 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://Ris.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 sis/. ❑ ZONING DISTRICT (CITY) can be found by contacting the Planning and Development Department or viewing the City's Zoning Atlas, available online at exteis.myclearwater.com/Zoning. ❑ SITE AREA (ACRES) can be found by viewing a Property Repott using Pinellas County's Public GIS Viewer available online at http://gis.pinellascounty.org/public gis/. _�CLEARWATER JimGHT AND sEAunrm• sAYTo 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.). Cl The proposed annexation is consistent with the City of Clearwater Comprehensive Pian. ❑ 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 Pian. PROPERTY OWNER AGREErOgNT Please be advised that, in consideration of the annexation, the property owners do hereby agree that: Q 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; f] 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. Plann:nn R navnlo% t an* ncnartmanf inn C UuMa Avanuu Mara .far FI VMA Tg& 797.KA9_d8M7• T- r --_) EARWATER 1 I BRIGHT AND BEAUTIFUL 'BAYTOBEACH Disclosu[^e ,.,_ PROPERTY OWNER (PER DEED): Brian Flaherty MAILING ADDRESS:( pa _/yin - cr tol, L PHONE NUMBER: _ ('p] 7 ) ? - d V0 _ 9 EMAIL: Bflahertyl@msn.com AGENT OR REPRESENTATIVE: MAILING ADDRESS: PHONE NUMBER: EMAIL: OTHER PERSONS HAVING ANY OWNERSHIP INTEREST -1 N THE SUBJECT PROPERTY: NAME: INTEREST IS: SPECIFIC INTEREST HELD: DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY? YES NO CONTRACT IS: PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: ;ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY? YES NO PARTIES INVOLVED —NAME: PHONE NUMBER: NAME: PHONE NUMBER: ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY?, YES NO PARTIES INVOLVED — NAME: PHONE NUMBER: NAME: PHONE NUMBER: STATE OF FLORIDA, COUNTY OF PINELLAS I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application. Sworn to and subscribed before me this �h day of 40A 0 / by •/' / , cJ who is personally known/has bf property- w- ner or representative Signature of property owner or representative produced / L J )L __\�v as identification. Notary phblic, // ;,.•t;;;�P�•.,, MYRAJAMES (/ ��` .'; Notary Public - State of Florida Myo issionexpires: =•; ' = Commission NGG088045 My Comm, Expires Mar 28, 2021 Bonded through Natlonal Notary Assn. Pinnninn R rfovoinnmon4 flonnrimont Inn C UvrHo Ovoniro f'ioanva4or CI 4479M To[- 797_499.dF97- S0 r--ICLEARWATERPlanning & Development D partment B�G"TMDBE'UMYMBEACH Petition for An exation Affidavit to Authorize Agent/Repre entative 1. Provide names of all property owners on deed —PRINT full names: R/' /,an OQ Apm& 2. That (I am/we are) the owner(s) and record title holder(s) of the following describ;/_7rty 30 6 S RN44 Avemve o 9 - ;)9 V/ - sla r o a Sia 3. That this property constitutes the property for which a request for (describer uest): 4. That the undersigned (has/have) appointed and (does/do) appoint: as (his/their) agent(s) to execute any petitions or other documen necessary to affect such petition; S. That this affidavit has been executed to induce the City of Cie rwater, Florida to consider and act on the above described property; 6. That site visits to the property are necessary by City repr entatives in order to process this application and the owner authorizes City representatives to visit and photo aph the property described in this application; 7. That (1/we), the undersigned authority, hereby certi that the foregoing is true and correct. Property Owner Property Owner Property Owner Property Owner ATE OF FLORIDA, COUNTY OF PINELLAS BEFORE ME THE UNDERSIGNED N 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 AT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED. Notary Public Signature Notary Seal/Stgrfip My Commission Expires: Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; C47 �. 'ICLEARWATER Planning & Development Department /BWrHTAM8EAUnML•BAYTOBEACH Petition for Annexation Supplemental Statement PROPERTY OWNER (PER DEED)- 9Jan Flaherty MAILING ADDRESS. CITY OF CLEARWATER CASE NUMBER: 4 P O - PCI vh C W pork)' -r X� ?y681 I/we, Brian Flaherty, 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 W Annexation of Contiguous Parcel(s): 1/we further agree and acknowledge that I/we shall not rescind the Petition for Annexation or execute any documents attempting such rescission, and that any attempted rescission shall be of no force and effect. ❑ Annexation of Noncontiguous Parcel(s): I/we understand that this annexation is voluntary, and that I/we may withdraw this Petition for Annexation prior to final action on this Petition by the City of Clearwater. I/we further agree and acknowledge, however, that receipt of all sewer, solid waste or other city service is contingent upon completion of the Petition for Annexation process, and that any withdrawal of this Petition prior to final action by the City, may result in a discontinuance and termination of all City -provided services. STATE OF FLORIDA, COUNTY OF PINELLAS I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my knowledge and authorize City representatives to visit and photograph the property described in this application�/� h Sworn o and subscribed before me this Y— day of 90 fir by who is personally known/has produced FC �L rs / as identification. Signature of property ner (individual or authorized representative of corporation, partnership or other entity) Notary pu My commission exp Signature of co -property owner MYRA JAMES Commission k GG 088045 P12nninn R nnualnnntanf nen!5.rfrt%&k%# inn C U.rfla Auanes& CJnanuofnr P1 R47" Tal- 797_A%A7_ArA7- 7 7 I#: 2005389864 BK: 14636 PG: 588, 09/27/2005 at 02:12 PM, RECORDING 1 PAGES $10.00 D DOC STAMP COLLECTION $0.70 KEN BURKE, CLERK OF COURT PINELLAS COUNTY, FL BY DEPUTY CLERK: CLKDMC1 v6rv� A299 Quitclaim Deed -e� QUITCLAIM DEED HIS QUITCLAIM DEED, Executed this CJ -1 dayof whose; office office addr*"js —Aj whose pdawftmimtess is '13S 33756 the said first party, for good consideration and for the sum of $ d by theysaidsecond party, the receipt whereof is hereby acknowledged, does hereby remise, release and qO'itclaini unto the said second party forever, all the right, tide, interest and claim which the said first patty has in and'i0,Ibe following described parcel of land, and improvements and appurtenances die" rrW in the Couof' �+w e k \ 0— State of 429 to wit: N4k V 4LC C a., dA -'s 76- J 41t 3 37 IN WITNESS WHEREOF, The said fust party has signed and the day and year first above written. /1", sealed and delivered in presence of: V State of County of SS. Then personally appeared to me known to be the person described in and who executed the foregoing instrument and "'k—k"gedbefore methat executed the same. Notary Public My Commission Expires: Alk qW Annexation Map Reques Planner Name: Kyle Brotherton Case Number: ANX2017-12025 Date Request Submitted: 12-12-17 Date Requested for: 12-22-17 Maps Needed ® Location Map ® Aerial Photograph ® Proposed Annexation ® Future Land Use Map ® Zoning Map ® Existing Surrounding Uses Map S ® 2" x 2" PDF Map (for Newspaper) L` p� Required Documents ❑ Legal Description ( arrancy de or survey) - to be hand delivered ® Map with Proposed i e ighlighted ❑ EDR - no hard copies submitted - all submission material is accessible through Accela Location & Right -of -Way Language (for Ordinance Title) Location: Generally north of Drew Street, south of SR 590, and within 'Amile west of McMullen Booth Road Right -of -Way [ENGINEERING INSERT RQW DES IPTIC?N CSR lA HERM PROVIDED LEGAL DESCRIPTION VERIFIED BY: v 13 11 Thomas Mahony, PSM, eo r phic Technology Manager MAP NAME Owner(s): Multiple Owners Case: ANX2017-12025 Property 1.687 Site: Multiple Addresses Size(Acres): ROW (Acres): Land Use Zoning PIN: See attached From : Residential Low (RL) R-3 & R-4 To: Residential Low (RL) Low Medium Atlas Page: 283A Density Residential