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° - T pEVELOPMENT DEP 0 Otten Street -Cheese Gromit LLC
PLANNING &TER -
CITY OF GLFARWP Zoning: LMDR - Low Medium Atlas #: 261A
I\N X201+ —o`t ` — -
ALL APPLICATIONS ARE TO BE FILLED OUT COMPLETELY AND CORRECTLY, AND SUBMITTED TO THE PLANNING &
DEVELOPMENT DEPARTMENT BY NOON ON THE SCHEDULED DEADLINE DATE. ALL PAGES WITHIN MUST BE SIGNED BY
ALL PROPERTY OWNERS LISTED ON THE DEED.
ONE (1) COMPLETE SET (1 ORIGINAL APPLICATION AND SUPPLEMENTAL MATERIALS) AS REQUIRED WITHIN IS TO BE
SUBMITTED FOR REVIEW BY THE DEVELOPMENT REVIEW COMMITTEE.
IT IS INCUMBENT UPON THE APPLICANT TO SUBMIT COMPLETE AND CORRECT INFORMATION. ANY MISLEADING,
DECEPTIVE, INCOMPLETE OR INCORRECT INFORMATION MAY INVALIDATE YOUR APPLICATION.
THE APPLICANT, BY FILING THIS APPLICATION, AGREES TO COMPLY WITH ALL APPLICABLE REQUIREMENTS OF THE
COMMUNITY DEVELOPMENT CODE.
APPLICATION FEE: $0
IMPACT FEE/ASSESSMENT FEE: TBD Information on Impact Fees or Assessment Fees is available from
the City of Clearwater Engineering Department (562-4747).
To Be Completed By City of Clearwater:
TYPE OF ANNEXATION: ><,"_ CONTIGUOUS NONCONTIGUOUS (TYPE A ENCLAVE)
To Be Completed By Property Owner.
MAILING
PROPERTY OWNER (PER DEED):
G t-} e- —5 C- G IrA,o to %'T
L_ L-- C -
MAILING ADDRESS:
t 86k q
PHONE NUMBER:
Z S8 o0 3
EMAIL:
grog..:�•-
AGENT OR REPRESENTATIVE:
D
S F.C> T 2b--
MAILING ADDRESS:
PHONE NUMBER: 7?—
EMAIL: EMAIL:
ADDRESS OF SUBJECT
PROPERTY: C7 citm j
PARCEL NUMBER(S): — I S—q(52%Z- dOp —opr,,v
LEGAL DESCRIPTION
CURRENT CITY SERVICES:
`T G CLQ- Pc — 14 t-- T L-7, � STS+ --rt= S L o T'
SANITARY SEWER
REQUESTED CITY SERVICES: <— SANITARYSEWER
(select all that apply)
SOLID WASTE/
RECYCLING WATER
SOLID WASTE/
RECYCLING WATER
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567;
Page 1 of 7 Revised 08.18.2016
1 ° l !s-111 BEAUMLI€-BAY TO MAOI
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): TL.
ZONING DISTRICT
PRESENT (COUNTY): jZ
REQUESTED (CITY): L M DR
SITE AREA: . I /,--. acres
SIZE OF DEVELOPMENT:
Existing:
Proposed:
(e.g., number of units, hotel rooms or
non- residential square footage)
USE OF PROPERTY:
Existing (currently on site):
Proposed (new use, if any;
plus existing if to remain):
If residential use, is unit(s)
rental?
F J J S! l ��
ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? YES ❑ NO
IF YES, PLEASE LIST/EXPLAIN:
Public State of Florida
My Commiaaion FF 097798
STATE OF FLORIDA, COUNTY OF PINELLAS A— Expir"
0, 3/0 912 0 7 8
I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the est 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 by
who is personally known/has
ej n%�Z � C.A-r__�sE_ (�-l�µ \! L—"C— proced � as identification.
Signature of property owner or representative
NotrVpublic,
My commissic
Signature of property owner or representative
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567;
Page 2 of 7 Revised 08.18.2016
C_E TER
t B IZII. munFUT; MY TO MCH
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 exttgis.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
__
�1 E A RWATE
�.SM EIT AM BLAU MUi.•BAY` O BEACH
ATTENDANCE AT PUBLIC HEARINGS
Planning & Development Department
Petition for Annexation
Information for AnDlicants
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
. — ......
�CLE ARWA
Planning & Development Department
Petition for Annexation
Disclosure Statement
PROPERTY OWNER (PER DEED): c- f-� &-m- f" L-`-- C --
MAILING ADDRESS: 1 mac-
PHONE NUMBER: 00341
EMAIL:
AGENT OR REPRESENTATIVE: c---,
MAILING ADDRESS:
PHONE NUMBER: + LA 2-
EMAIL: C n;? i ra,.,.: 4- ,'-�1 C-c-�
OTHER PERSONS HAVING ANY OWNERSHIP INTEPEST IN THE SUBJECT PROPERTY:
NAME: �
INTEREST IS:
SPECIFIC INTEREST HELD:
DOES A 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
PARTIES INVOLVED - NAME:
PHONE NUMBER:
NAME:
PHONE NUMBER:
ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY?
YES
PARTIES INVOLVED - NAME:
PHONE NUMBER:
NAME:
PHONE NUMBER:
X NO
X NO
X NO
': Nancy Marie Pierson
+a�6 My Commission FF 097798
STATE OF FLORIDA, COUNTY OF PINELLAS (orM1V Expires 03/09/2018
I (we), the undersigned, acknowledge that all representations made in this application ar
knowledge and authorize City representatives to visit and photograph the property described in this applic2�iL
Sworn t��subscribed before me this �`"� day of
Q �,,� DI —7 . by
WI` W � , who is personally known/has
G/ tkL"riL 6e421DM\,T- L—
ure
ure of property owner or representative
Signature of property owner or representative
ced
Nojarylj ublic,°
My commissionUires:
as identification.
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567;
Page 5 of 7 Revised 08.18.2016
. ... _........
WGIffr AND P,P1Ur1FU' BAY TO MCK
Planning & Development Department
Petition for Annexation
Affidavit to Authorize Agent/Representative
1. Provide names of all property owners on deed —PRINT full names:
2. That (I am/we are) the owner(s) and record title holder(s) of the following described property:
C' i Z `[ s� �I o z 1&8
C>C�5_0
3. That this property constitutes the property for which a request for (describe request):
j -,_-r', t',, r K Pr —r ( --- H
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
Th t (1/we), the undersigned authority, hereby certify that the foregoing is true and correct.
R
/tel CT R_ rr-- C'M t" i L - C.
Property Owner Property Owner
Property Owner
STATE OF FLORIDA, COUNTY OF PINELLAS
Property Owner
BEFORE ME THE UNDERSIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON
THIS DAY OF lPERSONALLY APPEARED
WHO HAVING BEEN FIRST DULY SWORN
DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED.
Notary Public State of Florida
Nancy Marie Pierson
RSea
My Commission FF 097798Expires 03/09/2018Notam
Notary Public Signature
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
EARINATER
"''� ARiGf7T R.*ID AERUTiFI. AAY'IL: AB�Cfi
Planning & Development Department
Petition for Annexation
SUDDlemental Statement
PROPERTY OWNER (PER DEED):
MAILING ADDRESS:
CITY OF CLEARWATER CASE
NUMBER:
/we, L_ t-.. c^
[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:
S� 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.
� �; Nancy Marie Pierson
� My Commiss'an fF 097798
STATE OF FLORIDA, COUNTY OF PINELLASaw� Expires o�o9rxo�a
I (we), the undersigned, acknowledge that all representations made in this applicati a c r t o t e of my
knowledge and authorize City representatives to visit and photograph the property described in this application.
Sworn to and subscribed before me this V day of
A n. by
"40� V�`�1 who is personally known/has
11111f r &-p C_4-'::, M,,T c.1 IC— produced as identification.
Signature of property owner (individual or authorized
representative of corporation, partnership or other
entity)
Nota 4p0"ificl
My commission exkrk C�4 () l I d0'
Signature of co -property owner
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567;
Page 7 of 7 Revised 08.18.2016
R
CLEARINMATER
BRUGH i AND BBAU11FUL • BAY TO BEACH
Case # ANX2016-04008
SIGN POSTING ACKNOWLEDGEMENT
I hereby acknowledge that the sign required for this case being considered by the
City of Clearwater for annexation was posted a minimum of 10 days before the
City Council first hearing. The sign was posted on the subject property in a
location where it is capable of being read from the most significant adjacent
street.
Planning & Development Department Staff:
Print Name
Sign Name
City Council Public Hearing Dates:
• June 14, 2017 (1St reading)
• July 20, 2017 (2nd reading)
Date Posted
June 1, 2017
Photo of sign uploaded into Accela
Date
Deadline to Post
June 4, 2017