PLANNING DEPARTMENT. Notice to applicant: Please read the following:

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PLANNING DEPARTMENT Application for a Type 3 Use For office use only: CASE NO. FILED: BY: PARCEL ID NO. FILING FEE: $ FILING DEADLINE: PRE-APP MTG: LPA HEARING: BCC HEARING: Notice to applicant: Please read the following: To assist you in completing this application and providing sufficient information upon which to base a decision on your request, please read the following: 1. Read the Application and instructions thoroughly; prior to filing this Application, the applicant and/or authorized representative is encouraged to call (727-464-3401) or visit the Zoning Division (located at 440 Court Street, 3 rd Floor, downtown Clearwater, FL) to review the application and proposal with staff. 2 All items in the Application must be completed. Additional documents (see item 16 in the application) and a filing fee are required. Checks may be made payable to the Board of County Commissioners. Note that once the application is advertised, filing fees will not be returned (information on filing fees is online at http://www.pinellascounty.org/plan). 3. The current owner of the property for which the Application is being made must sign the Application. These signatures must be notarized prior to submittal. 4. The applicant is encouraged to file the application well in advance of the filing deadline. Note that Applications received past the deadline will be processed on the next scheduled cycle. Deadlines, hearing schedules, filing fees and other information are available online at http://www.pinellascounty.org/plan or call (727) 464-3401 for more information. 5. The applicant or their authorized representative must be present at the public hearing(s). Failure to appear may result in a denial of the request. 6. It is recommended that the applicant or authorized representative contact the Zoning Division at (727) 464-3401 to schedule a Pre-Application meeting to discuss the proposed Type 3 Use prior to submitting an application. All information and documents required in the application, as well as the filing fee must be submitted at the time of application (see attached Fee Schedule). Incomplete applications will not be accepted for processing. Please contact the Zoning Division at (727) 464-3401 if you need additional assistance or information in order to complete the application. Thank you! Rev October 2018

The Board of County Commissioners assembly room provides a variety of presentation formats for your convenience. On hand is a 3'X3' presentation table with an overhead camera for TV monitor presentation of photographs, overheads, poster boards, maps, etc., (easels are no longer needed). This equipment is designed to be user and audience friendly and will enhance your audio/visual presentations. County staff will be on hand to assist you with the set-up of your presentation and with the operation of this equipment. Filing Fees for Type 3 Approval Requests: Under 5 acres: $1,410 5 acres and up: $1,850 After-the-fact: Double the amounts above Continuance: $350 Advertising fee: $350 For filing deadlines, hearing dates and other information, please call Pinellas County Land Use & Zoning at (727) 464-3401 or visit www.pinellascounty.org/plan.

1. Owner: Mailing Address: City: State: Zip Code: Daytime Phone: ( ) Email: 2. Representative s Name: Company Name: Mailing Address: City: State: Zip Code: Daytime Phone: ( ) Email: 3. Disclosure information (This information must be supplied pursuant to County Ordinance No. 74-15): A. If the owner is a corporation, partnership, or trust, list all persons (i.e. partners, corporate officers, all members of the trust) who are a party to such as well as anyone who may have a beneficial interest in the property which would be affected by any ruling on their application. Specify interest held: B. Is there an existing contract for sale of subject property: Yes No If yes, list names of all parties to the contract including all partners, corporate officers, and members of any trust: Is contract conditional or absolute? Conditional Absolute 3

C. Are there any options to purchase on subject property? Yes No If so, list names of all parties to option including all partners, corporate officers and members of any trust: 4. This Type 3 Use is being requested to consider: 5. Location of subject property (street address): 6. Legal Description of Property: (attach additional documents if necessary) 7. Size of Property: feet by feet acres 8. Present zoning classification: 9. Present Land Use Map designation: 10. Date subject property acquired: 11. Existing structures and improvements on subject property: 12. Proposed structures and improvements will be: 13. In order to authorize a Type 3 Use, the Board of County Commissioners must review the proposal against the criteria for granting of Type 3 uses found in the Pinellas County Land Development Code Section 138-241. Please demonstrate how your request meets each of the criteria below. This section is very important since the applicant must demonstrate to the Board through a showing of substantial and competent evidence that relevant criteria has been met to warrant approval (attach additional sheet if necessary): (a) The proposed use is consistent with the Comprehensive Plan and with the purpose and intent of the applicable zoning district: (b) There is adequate separation of the proposed use and structures from nearby uses by screening devices, buffer area, etc.: 4

(c) Adequate drives, walkways and parking are available or proposed so that no vehicular circulation or parking problems are created: (d) The proposed use will not create excessive vehicular traffic or other traffic problems: (e) Drainage problems will not be created on the subject property or nearby properties: (f) All requirements of the applicable zoning district will be met, unless otherwise varied: 14. Has any previous application relating to zoning or land use on this property been filed within the last year? Yes No When? In whose name? If so, briefly state the nature and outcome of the hearing: 15. Does the applicant own any property contiguous to subject property? Yes No If so, give complete legal description of contiguous property: 16. The following data and exhibits must be submitted with this application and they become a permanent part of the public records: a) Plat, if it will have particular bearing on the subject application. 5

b) Certification of Ownership: submit a certificate of a duly licensed title or abstract company, or a licensed attorney-at-law, showing that each applicant is the present title holder of record. (Warranty deeds, title insurance documents, tax receipts, etc. are not acceptable as proof of ownership.) c) A detailed concept plan drawn to scale showing the location and dimensions of all existing and proposed structures, setbacks from all property lines, signs, provisions for off-street parking, and a detailed statement of use. Ten (10) copies shall be required if the plan is larger than 11 inches by 17 inches. d) A recent survey of the subject property. e) Additional information may be required by Staff, such as, but not limited to, verification of adequate access to the subject area, documentation that any required specific use standards (see Chapter 138 Article IX of the Pinellas County Land Development Code) are being met and compliance with Airport zoning regulations, etc. 6

CERTIFICATION OF OWNERSHIP I hereby certify that I have read and understand the contents of this application, and that this application together with all supplemental data and information is a true representation of the facts concerning this request, that this application is made with my approval, as owners and applicant, as evidenced by my signature appearing below. It is hereby acknowledged that the filing of this application does not constitute automatic approval of the request and further that if the request is approved, I will obtain all necessary permits and comply with all applicable orders, codes, conditions and rules and regulations pertaining to the use of the subject property, while under my ownership. I am aware that attendance by me or my authorized representative at all public hearings relative to this request is required and that failure to attend may result in a denial of the request. It shall be my responsibility to determine time and location of all hearings. Date: STATE OF FLORIDA, COUNTY OF PINELLAS Before me this day of, 20 Signature of Owner, Trustee, or Officer or Registered Agent of Corporation personally appeared who, being duly sworn, deposes and says that the above is a true and correct certification. (signature) NOTARY PUBLIC (seal) *Applications which are filed by corporations must bear the seal of the corporation over the signature of an officer authorized to act on behalf of the corporation. 7