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--iANX2017-12024
r—"'1CL-EARi ANNEXATION
BR[GHTANDBEA John W. Gentry Inning & Development Department
Zoning: Atlas #: 283A Petition for Annexation
J
ALL APPLICATIONS ARE TO BE FILLED OUT COMPLETELY AND CORRECTLY, AND SUBMITTED TO THE
DEVELOPMENT DEPARTMENT BY NOON ON THE SCHEDULED DEADLINE DATE. ALL PAGES WITHIN MUST-BE-SIGNED--BY—
ALL
UST BESIGNED}-BYALL 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. a i
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): John W. Gentry
MAILING ADDRESS:
3120 Wolfe Road, Clearwater, FL 33759
PHONE NUMBER:
412-3084
EMAIL:
AGENT OR REPRESENTATIVE:
MAILING ADDRESS:
PHONE NUMBER:
EMAIL:
— -
ADDRESS OF SUBJECT
3120 Wolfe Road, Clearwater
PROPERTY:
PARCEL NUMBER(S):
09-29-16-05310-000-0130
LEGAL DESCRIPTION:
Bayview Bluff Lot M
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
JBRIGHT AND BEALITIML• 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 Urban (RU)
REQUESTED (CITY):
Residential Urban (RU)
ZONING DISTRICT
PRESENT (COUNTY):
R-3 Single Family Residential
REQUESTED (CITY):
Low Medium Density Residential (LMDR)
SITE AREA: 0.219
SIZE OF DEVELOPMENT:
Existing: 1
Proposed: 1
(e.g., number of units, hotel rooms or
non- residential square footage)
acres
USE OF PROPERTY:
Existing (currently on site):
Proposed (new use, if any;
plus existing if to remain):
If residential use, is unit(s)
rental?
Single Family
Single Family
A
ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? YES ❑ NO
IF YES, PLEASE LIST/EXPLAIN:
STATE OF FLORIDA, COUNTY OF PINELLAS
I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my
knowledge and authorize City representatives to visit and photograph the property described in this applicati°°��
Sworn to and subscribed before me this a�AZ day of
a O /4- by
who is personally known/has
produced ! z- DL s as identification.
of ptopekt> owner or representative
Notary puhlic, V
My commission expires:
Signature of property owner or representative
MYRA JAMES
�jetaFy Dw aIle - state of Florida
of Florida
Commission N GG 088045
My Comm. Expires Mar 28, 2021
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
r-!�CLEARWATER
BRIGHT AND BEAUTIFUL•BAYTO 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://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 gis/.
❑ ZONING DISTRICT (CITY) can be found by contacting the Planning and Development Department or viewing the City's
Zoning Atlas, available online at extsis.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:Hgis.pinellascounty.org/public eis/.
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865
Page 3 of 7 Revised 02/16
CLEARWATER
1 I BRIGHT AND BEAU"FU4• BAY TD BEACH
ATTENDANCE AT PUBLIC HEARINGS
Planning & Development Department
Petition for Annexation
Information for Applicants
The applicant or applicant's representative is encouraged to attend City Council public hearings unless the annexation
pertains to a property developed or to be developed with one single family dwelling.
STANDARDS FOR ANNEXATION
In determining whether to annex a property, the City shall consider the extent to which:
❑ The proposed annexation will impact public services (e.g., water, sewer, police, parks, etc.).
❑ The proposed annexation is consistent with the City of Clearwater Comprehensive Plan.
❑ The proposed annexation requires a change in the future land use and zoning classifications assigned to the
property as well as the jurisdiction for said change.
❑ Existing or proposed development is consistent with City regulations.
❑ Terms of a proposed Annexation Agreement, if any, promotes the City of Clearwater Comprehensive Plan.
PROPERTY OWNER AGREEMENT
Please be advised that, in consideration of the annexation, the property owners do hereby agree that:
❑ All structures and improvements which are erected upon said property subsequent to the date of this petition for
annexation shall comply with all applicable City of Clearwater regulations and ordinances as set forth in the City
Community Development Code;
❑ All residential rental units, including single-family residences must comply with the requirements in the city's
residential rental ordinance, which requires the property owner to obtain a Business Tax Receipt upon annexation
into the city;
❑ If development is to be initiated prior to submission of an annexation petition and/or prior to the effective date of
the annexation, requisite site plans, plat, and engineering plans shall be submitted to ensure compliance with the
city's Community Development Code (see Submittal Package Instructions Checklist). It is recommended that the
applicant meet with Planning and Development Department staff to review plans and/or discuss the applicable city
regulations;
❑ All annexations of residential dwellings of eight dwelling units or more shall convey such recreation facilities fees
and recreation land dedication and/or fees in the amount and manner prescribed by Chapter 54, Article II of
Clearwater Code of Ordinances; and
❑ When any substandard abutting street or utilities are subsequently upgraded by the City to meet City Standards,
said improvement(s) will be done on an assessment basis, consistent with City procedures therefore.
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865
Page 4 of 7 Revised 02/16
r-- `�CLEARWATER
BRIGHT AND BEAUTIFUL- BAY TO BEACIi
PROPERTY OWNER (PER DEED): John W. Gentry
Planning & Development Department
Petition for Annexation
Disclosure Statement
MAILING ADDRESS: 3120 Wolfe Road, Clearwater, FL 33759
PHONE NUMBER: 412-3084
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
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 '29 day of
Sit cZ,O /-�- by
who is personally known/has
produced /" t✓ U t! as identification.
Sigma f property ner or repres tat,
YRAJAMES
Notary public, """ 4
�'•, Notary Public -State offlorld�
My commission expires: .; » •- 4 5
Commissions mare .2 45
21
Signature of property owner or representative ''�' SFr;,.'Bonded throughNationalNotaryAM
Planning 81 Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865
Page 5 of 7 Revised 02/16
i
-") CLEA RWATER
I BRIGHT AND BEAUTIFUL- BAYTO BEACH
Planning & Development Department
Petition for Annexation
Affidavit to Authorize Agent/Representative
1. Provide names of all property owners on deed —PRINT full names:
John W. Gentry
2. That (I am/we are) the owner(s) and record title holder(s) of the following described property:
3120 Wolfe Road, Clearwater, FL 33759
3. That this property constitutes the property for which a request for (describe request):
Annexation in order to receive solid waste and sanitary sewer service from the City.
4. That the undersigned (has/have) appointed and (does/do) appoint:
as (his/their) agent(s) to execute any petitions or other documents necessary to affect such petition;
5. That this affidavit has been executed to induce the City of Clearwater, Florida to consider and act on the above
described property;
6. That site visits to the property are necessary by City representatives in order to process this application and the
owner authorizes City representatives to visit and photograph the property described in this application;
7. That (1/we), the undersigned authority, hereby certify that the foregoing is true and correct.
John W. Gentry
Property Owner
THIS
Property Owner
STATE OF FLORIDA, COUNTY OF PINELLAS
Property Owner
Property Owner
BEFORE ME THE UNDERSIGNED, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON
DAY OF , PERSONALLY APPEARED
WHO HAVING BEEN FIRST DULY SWORN
DEPOSED AND SAYS THAT HE/SHE FULLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED.
Notary Seal/Stamp
Notary Public Signature
My Commission Expires:
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865
Page 6 of 7 Revised 02/16
�(- �CLEARWATER
V BRIGHT AND BEALMFUL• BAYTO BEACH
PROPERTY OWNER (PER DEED): John W. Gentry
MAILING ADDRESS: 3120 Wolfe Road, Clearwater, FL 33759
CITY OF CLEARWATER CASE
NUMBER:
Planning & Development Department
Petition for Annexation
Supplemental Statement
I/we, _John W. Gentry
[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 [/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 0� 91 day of
SP,d a D ! by
, who is personally known/has
produced FL 0 L as identification.
re of property owner (in (ividual or uthorized
ntative of corporation, partners tp or other
entity)
Notary publiff
My commiss(iion expires:
Signature of co -property owner
_ NotaryPublic- StateofFlorida
Commission At GG 088045
My Comm. Expires Mar 28, 2021
Bonded through NatlonaI Notary Assn.
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater; FL 33756, Tel: 727-562-4567; Fax: 727-562-4865
Page 7 of 7 Revised 02/16
°..Clearwater
Planning & Development Department
Petition for Annexation
ALL APPLICATIONS ARE TO BE FILLED OUT COMPLETELY AND CORRECTLY, AND SUBMITTED IN PERSON (NO FAX OR
DELIVERIES) 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.
A TOTAL OF 6 COMPLETE SETS OF APPLICATION AND SUPPLEMENTAL MATERIALS (1 ORIGINAL AND 5 COPIES) AS
REQUIRED WITHIN ARE TO BE SUBMITTED FOR REVIEW BY THE DEVELOPMENT REVIEW COMMITTEE. APPLICATIONS
AND SUPPLEMENTAL MATERIALS ARE REQUIRED TO BE COLLATED AND STAPLED INTO SETS.
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: TSD Information on Impact Fees or Assessment Fees is available from
the City of Clearwater Engineering Department (562-4747).
To Be Completed By City of Clearwater:
TYPE OFANNEXATION: X CONTIGUOUS NONCONTIGUOUS (TYPE A ENCLAVE)
To Be Completed By Property Owner:
PROPERTY OWNER (PER
Thomas H. and Thea Kinseher
DEED):
MAILING ADDRESS:
3124 Wolfe Road, Clearwater, FL 33759-3541
PHONE NUMBER:
727-687-2344
EMAIL:
tkinseher@gmail.com
AGENT OR REPRESENTATIVE:
MAILING ADDRESS:
PHONE NUMBER:
EMAIL:
ADDRESS OF SUBJECT
3124 Wolfe Road, Clearwater, FL
PROPERTY:
PARCEL NUMBER(S):
09-29-16-05310-000-0120
LEGAL DESCRIPTION: Bayview Bluff Lot L
CURRENT CITY SERVICES: SANITARYSEWER X SOLID WASTE Rec Only WATER
REQUESTED CITY SERVICES. SANITARY SEWER X SOLID WASTE
(select all that apply)
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727562-4865
Page 1 of 7 Revised 04!15
or�
0 earwat�r Planning & Development Department
- - Petition for Annexation
U
Data Sheet
PLEASE ENSURE THAT THE FOLLOWING INFORMATION IS FILLED OUT, IN ITS ENTIRETY. FAILURE TO COMPLETE THIS
FORM WILL RESULT IN YOUR APPLICATION BEING FOUND INCOMPLETE AND POSSIBLY DEFERRED UNTIL THE FOLLOWING
APPLICATION CYCLE.
FUTURE LAND USE PLAN DESIGNATION
PRESENT (COUNTY): Residential Urban (RU)
REQUESTED (CITY): Residential Urban (RU)
ZONING DISTRICT
PRESENT (COUNTY): Single Family Residential (R-3)
REQUESTED (CITY): Low Medium Density Residential (LMDR)
SITE AREA: 0.22
SIZE OF DEVELOPMENT:
Existing: 1 unit
Proposed: 1 unit
(e.g., number of units, hotel rooms or
non- residential square footage)
acres
USE OF PROPERTY:
Existing (currently on site):
Proposed (new use, if any;
plus existing if to remain):
If residential use, is unit(s)
rental?
Single -Family Residential
Single -Family Residential
ARE THERE ANY ACTIVE/OPEN PERMITS FOR THE PROPERTY WITHIN PINELLAS COUNTY? YES 11O
IF YES, PLEASE LIST/EXPLAIN:
STATE OF FLORIDA, COUNTY OF PINELLAS
I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my
knowledge and authorize City representatives to visit and photograph the property described in this applicati n
Sworn to and s`u,�bscr_ibbed before me this O' LA -M day of
V Q5�(�Vk. ( CL�. by
-TXM 6-s T1>CL who is personally
known/has ,
9,roduced �\V�5 UC-,Wc6Q as identification.
Sigfieture of property owner or representative
Notary public,
xs Z a.0a
Signature of property owner or representative ;�e►l�y �t
>Hi,� DANIEU.E SHIRE
°:'� e3i'i�:a� EXPIRES: April 13, 2021 1
yhnn
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-662-1865
Page 2 of 7 Revised 04/15
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. [Note: Submit two copies only]
❑ 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. 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). [Note:
Submit two copies only]
❑ 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). [Note: Submit original only]
❑ If applicant is designating an agent/representative to work with City, applicant must provide notarized Affidavit to
Authorize Agent/Representative (form attached). [Note: Submit original only]
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:Hgis.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
http://www. myclearwater.com/gov/depts/pwa/engin/publications/engatlas/atias.a sp.
❑ SITE AREA (ACRES) can be found by viewing a Property Report using Pinellas County's Public GIS Viewer available online
at http://gis.pinellascounty.org/public—gis/.
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727-562-4865
Page 3 of 7 Revised 04/15
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: 727-562-1567; Fax: 72756211865
Page 4 of 7 Revised 04/15
'Clearwater
PROPERTY OWNER (PER DEED): Thomas H. and Thea Kinseher
Planning & Development Department
Petition for Annexation
Disclosure Statement
MAILING ADDRESS: 3124 Wolfe Road, Clearwater, FL 33759-3541
PHONE NUMBER: 727-687-2344
EMAIL: tkinseher@gmail.com
AGENT OR REPRESENTATIVE:
MAILING ADDRESS:
PHONE NUMBER:
EMAIL:
OTHER PERSONS HAVING ANY OWNERSHIP INTEREST IN THE SUBJECT PROPERTY:
NAME:
INTEREST IS:
SPECIFIC INTEREST HELD:
DOES A CONTRACT EXIST FOR SALE OF THE SUBJECT PROPERTY?
YES X NO
CONTRACT IS:
PARTIES INVOLVED— NAME:
PHONE NUMBER:
NAME:
PHONE NUMBER:
ARE THERE ANY OPTIONS TO PURCHASE THE SUBJECT PROPERTY?
YES X NO
PARTIES INVOLVED— NAME:
PHONE NUMBER:
NAME:
PHONE NUMBER:
ARE THERE ANY MORTGAGES OR LIENS ON THE SUBJECT PROPERTY?
i/ YES NO
PARTIES INVOLVED— NAME:
PHONE NUMBER: gq-6--i
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 aday of
LkWbe-Y-- . aOk'l_. by
k1�cwn/ha °�hRC� k� t1gQ�lQ f who is personally
known/ha
roducedr1�%��S C-QYIS-� as identification.
/ tea✓ P
of property owner orepresentative
Signature of property owner or representative
Civ
Notary public,
DANIELLE SHIRE '
MY COMMISSION # GG 94
EXPIRES: April 13. 2021
Planning & Development Department, 100 S. Myrtle 62-4567; Fax: 727-562-4865
Page 6 of 7 Revised 04/15
°:Clearwater
0 �' -�- �� �� �� ��
1.
2.
3.
4.
5.
6.
7.
Planning & De,
Petition
Affidavit to Authorize
V ent Department
Annexation
iresentative
Provide names of all property owners on deed — PRINT full names:
Thomas H. Kinseher Thea H. Kinseher
That (I am/we are) the owner(s) and record title holder(s) of the followi described property:
3124 Wolfe Road
That this property constitutes the property for which a request fo (describe request):
Annexation of single family residence
That the undersigned (has/have) appointed and (does/d appoint:
as (his/their) agent(s) to execute any petitions or
That this affidavit has been executed to induce
described property;
ier documents necessary to affect such petition;
City of Clearwater, Florida to consider and act on the above
That site visits to the property are necessa by City representatives in order to process this application and the
owner authorizes City representatives to v' it and photograph the property described in this application;
That (1/were undersigne0aulhprity,fiereby certify that the foregoing is true and correct.
Property 6wner
Property O ner
STATE OF FLORIDA, COUNTY OF PINELLAS
Property Owner
Property Owner
BEFORE ME THE UN RSIGNEED`,, AN OFFICER DULY COMMISSIONED BY THE LAWS OF THE STATE OF FLORIDA, ON
THIS DAY OF 1VC��Ia�Y ►� �V�,i 17C5U, PERSONALLY APPEARED
DEPOSED AND SAYS THAT H
DANIELLE SHISE
MY COMMISSION # GG 94068
EXPIRES: April 13, 2021
Notary S96l/Stamp
WHO HAVING BEEN FIRST DULY SWORN
LLY UNDERSTANDS THE CONTENTS OF THE AFFIDAVIT THAT HE/SHE SIGNED.
y Public Signature
My Commission Expires:(
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727562-4865
Page 6 of 7 Revised 04/15
PROPERTY OWNER (PER DEED):
MAILING ADDRESS:
CITY OF CLEARWATER CASE
NUMBER:
Planning & Development Department
Petition for Annexation
Supplemental Statement
Thomas H. and Thea Kinseher
3124 Wolfe Road, Clearwater, FL 33759-3541
I/we,-7-knrync 4, cZ✓1d 1 Veo- F+- k!i7Strk
[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): 1/we further agree and acknowledge that I/we shall not rescind the Petition for
Annexation or execute any documents attempting such rescission, and that any attempted rescission shall be of no force
and effect.
❑ Annexation of Noncontiguous Parcel(s): I/we understand that this annexation is voluntary, and that I/we may withdraw
this Petition for Annexation prior to final action on this Petition by the City of Clearwater. I/we further agree and
acknowledge, however, that receipt of all sewer, solid waste or other city service is contingent upon completion of the
Petition for Annexation process, and that any withdrawal of this Petition prior to final action by the City, may result in a
discontinuance and termination of all.City-provided services.
STATE OF FLORIDA, COUNTY OF PINELLAS
I (we), the undersigned, acknowledge that all representations made in this application are true and accurate to the best of my
knowledge and authorize City representatives to visit and photograph the property described in this application.
Sworn to and subscribed before me this �;yy- day of
Kkx-n � a�_l . by
n17�ly�i_S //
"4 who is personally
known/has
roduced \r';kj"5 LSC as identification.
Signature of property owner (individual or authorized
representative of corporation, partnership or other
entity)
Signature of co -property owner
Notary public,
My commission expires: Ay-';
MY G9MMMIpN # 00 94058
EXPIRES: April 13, 2021
Planning & Development Department, 100 S. Myrtle Avenue, Clearwater, FL 33756, Tel: 727-562-4567; Fax: 727562-4865
Page 7 of 7 Revised 04/15
�;'�M A55WlAl5fV!'hlyjNj�.
............ .
E V TER
BRIGHT AND BEAUTIFUL • SAY TO BEACH
Case # ANX2017-12024; ANX2017-12025; ANX2018-01002
SIGN POSTING ACKNOWLEDGEMENT
I hereby acknowledge that the signs required for this case being considered by
the City of Clearwater for annexation were posted a minimum of 10 days before
the City Council First Hearing meeting. The signs were posted on the subject
properties in a location where they are capable of being read from the most
significant adjacent street.
Planning & Development Department Staff:
Piinf Name
St'g-n Name
City Council Public Hearing Dates:
• March 15, 2018 (1St reading)
• April 4, 2018 (2nd reading)
Date Posted
March 2, 2018
Photo of sign uploaded into Accela
3 -2— to
Date
Deadline to Post
March 5, 2018
Annexation Map Request
Planner Name: Kyle Brotherton
Case Number: ANX2017-12024
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
® 2" x 2" PDF Map (for Newspaper)
Required Documents
❑ Legal Description ranty d d or survey) - to be hand delivered
® Map with Propose ighlighted
❑ EDR - no hard copies submitted - all submission material is accessible through Accela
Location & Right -of -Way Language (for Ordinance Titie)
Location: North side of Wolfe Road approximately 390 feet east of McMullen Booth Road.
Right -of -Way: [ENGINEERING INSERT ROW DES R PTION OR N HER
PROVIDED LEGAL DESCRIPTION VERIFIED BY: 4,0
111
Thomas ahony, PSM, eographi T chnolody Manager
MAP NAME
Owner(s): Multiple Owners
Case:
ANX2017-12024
Site: 3120 Wolfe Road
Property
Size(Acres):
0.440
3124 Wolfe Road
ROW (Acres):
Land Use Zoning
PIN:
09-29-16-05310-000-0130
Residential Urban
09-29-16-05310-000-0120
From : (RU) R-3 Single Family
Residential Urban Low Medium
To:
Atlas Page:
283A
(RU) Density Residential