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APPLICATION I~OTICE OF .. MUNICIPAL ANNEXATION FROM: City of Boynton Beach, Florida Please be advised by this notification and attached location map, that certain lands have been annexed by BOYNTON BEACH, Florida. Information contained herein is pertinent to the area in question. If additional material is required, please contact the office of: THB CITY PLANNBR. Name of Development/OWner: KNOLLWOOD GROVES Ordinance . Q9~-35 or Special Act of State Le;islature. Bill' Effective Date: OCTOBER 18, 1994 Area of Subject Property: Estimated Present Populationt 0 Estimated Number of Existing Dwelling Units: 0 Sq.rt. 30 Acres Estimated Present Residential Density: N/A d. u. 's/ acre Zoning: AG AGRICULTURE pensity Allowed: 1 du/2.5 acres d.u.'s/acre Existing Type of Development: ~ITRUS GROVES AND MARKET Proposed Type of Development: N/A *OWner or Petitioner *County Commi..loners *County Planning, Bld;, Zoning *Area Planning aoard *Countywide Planning Council All City Departments Al~ Utility Comp~nies Chamber of Commerce Bureau of Census *County Tax Assessor *Secretary of State *Supervisor of Registration *State Beverage Department *Clerk of County Circuit Court to receive copy cf ordinance Attachment Location Map *State Department of Transportation --........ .~ ']:),-/ /(1. .lc'~~ I ~-v_i. ~_ (T') ........ ........ IJ"") co c::> C"l"') IX) - .- .. ':;:: ;I c =- -: . :::c i, ,~ 't:) rtl CJ) CQ ~ o .jJ ~ :>t o CQ 4-l o :>t .jJ .~ u CJ) .c: ~ 8 J ""': .. 3 :>t ~,Q ~ 'J) '0 ~ Q) ..-1 I-l I'll :Jl 0.. .,..j CJ) .c ~ ~ 0.. ;'"'; (e.e) ;! J. .nl .~: 1~1 ~' 0...: ; , I cnj C"I"J I en' I ('l"j: Cl:41 : '''''> ~ cY) cY) ~..a C\1 ..!!! ~ :g (..) cu .9 .z=-cc u... c:s c:: - cu.s~"5 .. ; ~(V') m o O><CD ~ - CD 0 c:-' 0 cot:: cu '0 0 ~ ~ ~o ~ ~ C5 i::3 a: d5 w lY: -v.) l , AGkED1~L~ FOR WATER SERVICE OD~SIu~ THE CITY LIMITS II -~ This agreement, made on this 26th day of II 19~ by and between KNOLL,lOOD G:WVE3, INC. I hereinafter called the CUSTOMER, and the CITY OF BOYNTON BEACH, a ;1 ~unicipal corporation of the State of Florida, hereinafter called " the CITY. APRIL , WITNESSETH, that the CUSTOMER, his heirs and assigns, for and ~n consideration of the privilege of receiving water service from the Municipal Water System agrees to the following: 1. The CUSTOMER agrees to pay all costs of engineering, ~?t8rialsJ ~2bor, installation, and inspection of the facilities ~:". required by the City Code to PFovide serViCE! to the CUSTOMER'S premises. The CUSTOMER shall be responsible for installation and conformance with all epplicable codes, rules and regulations of all service lines upon the CTJSTOMER'S premises and all such lines i shall first be approved by the Director of Utilities and subject I to inspection by the City Engineers. The CITY shall have the j option of either requiring the CUSTOMER to perform the necessary :: work or the CITY may have such work performed in which case the .\ CUSTOMER will pay in advance all estimated costs thereof. In the event the CITY has such work performed, the CUSTOMER will also ;' advance such additional funds as may be necessary to pay the tota~. actual costs. 2. Any main extension made under this Agreement shall be used only by the CUSTOMER, unless permission is granted by the City of Boynton Beach for other party or parties to so connect pursuant to the Code of the City of Boynton Beach. 3. Title to all mains, extensions and other facilities ex- tending from the City water distribution system to and including j' I' the meter tv service the CUSTOMER shall be vested to the CITY exclusively. 4. The CUSTOMER agrees to pay all charges, deposits, and rates for service and equipment in connection with water service outside the City limits applicable under City Ordinances and rate schedules which are now applicable or as maybe changed from time II to time. I I 5. Any rights-of-way or easements necessary shall be provid- ed by the CUSTOMER. 6. It is understood by the CUSTOMER, and shall be binding upon the CUSTOMER, his transferees, grantees, heirs, successors and assigns, that all water to be furnished, supplied, and sold under this Agreement is made available from a surplus. If a surplus does not exist at the time of CUSTOMER'S actual request for commencement of service, as determined by the City's Director of utilities, then the CITY without liability may refuse to initiate service to the subject premises. 7. Th6 CUSTOMER further agrees in consideration of the privilege of receiving water service from said CITY, that the execution of this Agreement is considered a voluntary Petition fo~ annexation pursuant to Section 171.044 of the Florida Statutes or any successor or amendment thereto. Furthermore, should any othe~ general law, special act, or local law be enacted which provides for voluntary or consensual annexation this Agreement shall also be considered a Petition and request for annexation under such other laws* The premises shall be subject to annexation at the option of the CITY at any time they are eligible under anyone or ~ore ot th~ above referenced laws concerning annexation. (1 ' -J i I 'I \1 d ,1 " !l 'I . ,l .j j , " ! " ., CO \1 CQ , ., ~ , I 0- CT) (T') c;o : ('l") CD " :1 The CUSTOMER acknowledges that this covenant for annexa- I tion is intended to be and is hereby made a covenant running with I the land described in "Exhibit A", attached hereto and made a part ! hereof. This Agreement is to be recorded in the public records of j11 Palm Beach County, Florida, and the CUSTOMER and all subsequent transferees, grantees, heirs or assigns of CUSTOMER shall be bound by this annexation Agreement. I 8. It is agreed that the City shall have no liability in the avent there is a reduction, ~mpairment or termination in water , service to be provided under this Agreement due to any prohibition:3, restrictions, limitations or requirements of local, regional, State or Federal agencies or other agencies having jurisdiction over such matters. Also the City shall have no liability in the event ,~ there is a reduction, impairment or termination of water service ;i due to acts of God, accidents, strikes, boycotts, blackouts, fire, earthquakes, other causu:.ll.ties or at,her circumstances beyond the II I City's reasonable control. i ,I 9. The CUSTOMER hereby agrees to indemnify, defend and hold' I' q harmless the City of Boynton Beach, Florida, its Mayor, Members of: I, City Council, Officers, employees and agents (both in their in- ' :1 dividual and official capacities) from and against all claims, " damages, law suits and expenses, including reasonable attorneys' II fees (whether or not incurred on appeal or in connection with post il judgment collection) and costs arising out of or resulting from tt~ 'i CUSTOMER'S obligations under or performance pursuant to this Agree.- " jl menta il Ij 11 " ! 10. No prior or present agreements or representations shall be binding upon any of the parties hereto unless incorporated in this Agreement. No modification or change in this Agreement shall be valid or binding upon the parties unless in writing executed by the parties to be bound thereby. IN WITNESS WHEREOF the parties hereto have executed this Agreement the day and year first written. WITNESS: CfmnJ 0 thmtlAnau~ ~~ Coti.-~~ .=\s to ustOmer .Il ~ND ~I~Ul\~ (S~l\~. ,OWNER (f) : _ (r;ft'l/{/J:., /.;{;l--U- /11./ PRESIDENT (/. .%d,{. Vel 1 Customer ' .t;CHt;'l'AKY (; FOR INDIVIDUAL(S) NOTORIZATION: STATE OF FLORIDA ) :OUNTY OF PALM BEACH ) I HEREBY CERTIFY that on this day, before me, an officer dul~- authorized in the State aforesaid and in the County aforesaid to take acknowledgements, personally appeared ROBERT STERN. JR. G; ROBERT C. OCHS. JR. , to me known to be the perso~ 1escribed in and who executed the foregoing instrument and th8X acknowledged before me that they executed the same. WITNESS my hand and official last aforesaid this 26th day of County and State ;, 19B}. (Notary Seal) ~ .. ~...,.. .' (;". - My Commission ~xp~~es: .......;.:.:......~- - -- .. ,~.. ;.;'i.ARt ili..:6i...'~ :T.\fE O~. ;10~lOll, ""~I ::.);'.",;.~~,,.;,.'l ,,\j-,~; ~c~~ ,:.h \'>[;,'. ~ni, Gfttit~ "'''~I..,,"r< '" (2) ""- cc. ; 0') '- 0") (Y) C') I ('r) . co 0.:.. .' , :1 I. I CITY OF JYNTON BEACH, FLORIDA ;/ By':_ ,'~.(//-'-:" /~~/7A ~ 12-- - ./" L /'/ .?VF~/~-~ / / Ma r v/ ,r ./1 /) "~. / ATTEST. /)-'7} .~ .. // .. ~ y C.L~rk ....". : ... ,. \ l ,'. ,(co:rp.,;se.ct~..'l ~,.l ~ ~ J,) . . ~ .,. '''., '- ., ......' 1 /' / '-~N (7<'/ . l..<1':€ .7,r'~ '-f. V/~ -// I . / v~/~.< 7..L/ As o~ ~ Y of Boynton each STATE OF FLORIDA , ,I :; COUNTY OF PALM BEACH ) 11 . .' , , - i ,. I HEREBY CERTIFY thc.lt on this day, before me an officer.-duly I authorized in the State aforesaid and in the County aforesaid to take acknowledgements, personally appeared JAMES R. WARNKE , Mayor and BETTY S. BORONI ,City Clerk well known to me to be the Mayor and City Clerk respectively of the City named in the foregoing agreement and that they severally acknowledged executing the same in the presence of two subscribing witnesses freely and voluntarily underl authority duly vested in them by said City and that the City seal I affixed thereto is the true corporate seal of said City. , .... I j WITNESS my hand and official seal in the County ,. a~oresaid this --2.!..h day of May , 1983. (NOi;,,!ry Se"!l) G---k . ~ ~iC i I , 1 . and State 1a~j. i-, , . .'~ . '. I !;~. My Commission Expi \ '.. ._1 Approved as to form: Notarv Publi(, State of :::vr:c" Mv Commission Expires Oct. 2~, 1986 __ landed Thru Troy Fai,. . 'nJuranc., Inc., 9n,_ y~ ~ City Attorney I I I Legal Dr APproved; h//. ~~ ;1 c~ ty Eng~neer 'I II II II I' 'I ~ I .1 ---. il (3) .. .. a . - ~ ~\ ~ ~\ .a 1 .. ....' , ,~ " 2\~ 0 ::.6/ (J '"" u ,,":\. ~ it\ ~. ..:> ,., .1' Z - -f" U 0 - t-':C ~ c) ..:{ 0 ~ , o\~ (J) \ ~, \.\l :; , , ... cr. ex -\~ ::--- u-) ;'. - C) ::> :cc' - - ,. . = - = .~.~~..........~ -. - -= ~ ..... \,,;''- \, : ,,:,..' ,.. ..' 1 i.l1!f/1 C I T Y o F BOY N TON B E A C H PLANNING & ZONING BOARD ANNEXATION APPLICATION NOTE: This form must be filled out completely and accurately and must accompany all applications submitted to the Planning Department. (2 copies of application required. ) PROJECT NAME: !:Ylci/{,Jooca. GY""C\ dc...S - A,.,,,(!>j(c~.f-,0Y7 f}.~(o''fY1 CJ:>ho.se 2.J c;,o ,..;p.t) AGENT'S NAME: ADDRESS: OWNER'S NAME: K"Y'\6/lluccr:!:... GTe .r~~ IV'\<z-. (or trustee's) ADDRESS: ~J Lo-orc.. YlCe. Roa-a Boy)? 1b." & o.c I. ,;::-1. .3.3~~ , , PROJECT LOCATION: 5}(')vrAtJe-"d- COI'1')~:(' aP L/~(.frC.w"IC<::'" Rd. c:>-"cL (not legal description) .K lflollcJoo.I1 "Kc(, CORRESPONDENCE ADDRESS:* (if different than agent or owner) *This is the address to which all agendas, letters and other materials will be forwarded. PLANNING DEPARTMENT - APRIL 1991 A: AnnxAppl . ( 2) C I T Y o F BOYNTON B E A C H APPLICATION FOR ANNEXATION INSTRUCTIONS All properties within a single application must be contiguous and immediately adjacent to one another, or be the subject of separate applications. No application shall be accepted unless it is presented on the official form of the City of Boynton Beach, Florida. The applicant must submit two copies of this application and other required information. Before an application may be accepted, it must fully comply with all required information as stated below. ATTACH THE FOLLOWING REQUIRED INFORMATION TO THIS APPLICATION: 1. a. A copy of the recorded subdivision plat if the subject property is a lot or lots of record. or b. All other property must be shown on a certified legal survey made by a surveyor registered in the State of Florida and drawn to a scale appropriate to the size of the subject property. The legal survey shall include an accurate legal description of the subject property to be annexed, and a computation of the total area of the subject property, computed in square footage and to the nearest one-tenth (1/10) of an acre. 2. A statement of the applicant's interest in the property to be annexed, including a copy of the last recorded Warranty Deed, and: a. If joint and several ownership, a written consent to the annexation petition by all owners of record, or b. If a lessee, a copy of the Lease Agreement and written consent of the owner, QE c. If an authorized agent, a copy of the Agency Agreement or written consent of the seller/owner, or d. If a corporation or other business entity, the name of the officer or person responsible for the application and written proof that said representative has the delegated authority to represent the corporation or other business entity, or in lieu thereof, written proof that he is in fact an officer of the corporation or other business entity, or e. If a contract purchase, a copy of the Purchase Contract and written consent of the seller/owner. COMPLETE THIS APPLICATION FORM AND SUBMIT WITH REQUIRED ATTACHMENTS TO: CITY OF BOYNTON BEACH PLANNING DEPARTMENT 100 E. BOYNTON BEACH BLVD. P. O. BOX 310 BOYNTON BEACH, FL 33425-0310 (407) 738-7490 PLANNING DEPARTMENT - APRIL 1991 A: AnnxAppl ( 3 ) C I T Y o F BOYNTON B E A C H APPLICATION FOR ANNEXATION DATE APPLICATION FILED: ~/-/- 9f" DATE OF TENTATIVE APPROVAL: DATE OF COMPLETION OF ANNEXATION REPORT: DATE OF ORDINANCE PROPOSAL: DATE OF ORDINANCE ADOPTION: DATE OF REFERENDUM IF REQUIRED: RESULTS OF REFERENDUM: FOR: REJECTION: ORDINANCE # REJECTION: AGAINST DATE ANNEXATION BECOMES EFFECTIVE: DO NOT WRITE ABOVE THIS LINE FOR DEPARTMENTAL USE ONLY GENERAL DATA Name of Developer fOWner: R')"1C)/~J~ocU GroLlQs ..z;,c,. Area of Subject Property: Sq. Ft. or 30. () Acres Estimated Present PopUlation: 0 Existing Zonin<4: AR-SE ~ic.jt<.t(""GJ Density Allowed: ~':s..IJ.C(""\1\(..J. S=7i;;J: 5::c.coq:>-ft'"'^-~ Covy\~c:..i,,-( S....(.c.s / S:z.n/-'c:.c:."f 1-'" c:.tcvs ~d~+jo.,..., Proposed Zoning: A G ~ ic t.; l-fl,)ye. Dens i ty Allowed: .1 d.u.'sf 10 <>c'('"<z:-:. .t. d.U.'S/ 01 S ccre.5 EXISTING UTILITIES: Water: C; t:-V Wastewater Collection: N /A Solid Waste (garbage): Coc.n\i:.-y PLANNING DEPARTMENT - APRIL 1991 A: AnnxAppl (4) STATEMENT OF USE Existing Use: A,;'iicul-furc- (:Jrovc-<:;. c;...ndl rc::..ld-f-eL) re...l-o-;() Proposed Use: A-6 c hr~J 7Jrono:S~d / / JUSTIFICATION Express in your own words why this annexation will be beneficial to Boynton Beach, Florida: AYn1~ )(a.+/CIt'"l prc'\Jra--rn - P hl...'!:.<:?- .;z / r;.rour 1- ((.,rJ..+c c .s~("v'7"c.e. Q...3~'YYIe..'h+ p rdfe.r+y) EXACT LEGAL DESCRIPTION OF PROPERTY TO BE ANNEXED /h~ Y>c1r.f-'h % r/' -I-ie. n(Y("'~ c: G- <::.. I' / / 4f 0 f r f, It': YJc.r~ (C>O- S -r //~ O--nd2 +i.e.. /J~~~a-s;'- ~ o/' -Ii ~ nr'~d (.Jt::.sr- ~~ <Jf ;--h t!.. Yh.('",n, eo-oS r ~/.y o-!' "'0::-,.f-,,'e7n /:1.-, ~r"Y'\ '5 h ,y, "7"'.S; R~JIt': J/~, ~Jq~I-f,e.Y' ~r-f-J, L.U.J.:).D~ L-';;O Co-Y1o..( J2/GJ .,-.-6-...,I-f,r.<=7 rlor+1. ",I ~ ilto'2'>erry. ../ " / PLANNING DEPARTMENT - APRIL 1991 A: AnnxAppl lS) 5;11 ..:. .J ~ _ - 'Y ... u\~~" '- J .....'.> '7~. P~\l. . ":' ~ ~ ~~.i '!l · -""'I ~ ~. _' .~: e~i~~ ~ \ "'~'\'11IC .,..... \' ~. 'I ...." .' ...~ ~..... " '.. .S~ I ~ ;i~' i~ i! 'It ~,,,. . i .' ,~ 1~~" .,~1' . __ . ~~. -":.;.h~' '~~1 . lit ! , "'iV\ -\--' . ~; ~A'\,ij ,,,-, - · fJ... \ I 'l.t:i"~' !~~ ~;~.~I . ~~I~'\kll. . ~. r;.; ~~A ". . J ::1:" \.~ \': ,'[1 ; r:-- ~ \ .. ~ 'f' " .....0'., ,-, ,,,,,,. ' I) ~ .. '.L'1i:-" en"" ,t;<"I' ,,<..! I' !<:: .M~' ~\J ' ~ ...... ",",",,'" J ,. """''':\'i::''' i, F:'" :.. j' """'" .. <lrf~ "'~,;' :"K;,~' .. ,\ '\ '? ,rt.. \ t\ . "': · · ~ f' : ;;. ~,,'~ 1 i~~Jr.h..~ & e : ' " ~ / ~:--_" '.~~ _ ~ ~'\lIJ14F'\~' .' ,.,~'.: \ \ ~'~ 1 ~ ~' ~ \ I \ l-: I\~? . lI!tt~" ~ .:. .' s-' ~~~ ~ P::':.c1 _ r;" ~ ,,'" ",., 1~"'" ':ll '"' """ ,_I-=-;} ,..' ~ .' .'n!' r,,~ ., ' ~" ' ' !;:i ~'-, . ~ _ ....'T. . ,I 1~!:O~t ....!. '.. . ;'j\ ::T~ ':~-. '? ~ f: j 'I ~ J~71a,~,Y~f~f~.(-;~. ~\~~!.. f4;~:~~": .~ . ~ .'\\>~~{ "). -,,;\.1/";'<';' _~~.'::>. . \ ~', -:" ~.. ...i \ ""\' ~,~~.::~'~~~~{;?)~ " C'>" .'~~I!'::t1 ;q~:~ ~' G..... ..~.~~~ ''''ltl!I\,,~I,~~~I'''!'''''''~.~i'~' ..~~.- ,..',...,\.....,....J ., " ." ..~- . ,,'~", ,.." " , . ,~;.:,; .< ..' ,- L. . \ - ':-:: ~H1II' (fl...(.:. \~)'l- \ ., . :~'.'''' tn ' ..,' ~'.:{.'.l ... ,-', u~ . \'r ' ~ &-.. ~ ;..' ~' _~ '" j WL \ \lI~~~;':-=.' .,....:\ ..J, i,~ V'~/$ .' ~ d f'~ ~I ..~. (' ~"'\( \ "L.....JI'i.1"'^ -:0:" · '11 "" ",' ~ .- I";' ,'7'r' ["""" .",. . ~ ,. ,: \ ~ ,,' ' -. I!!~ " . ... .", .~:'. "'l"lJ:T' ,\\1' e I -. ".,..'. , .' I' , ' ,~ \'. .' - I ;,;" , _ ~\ ~~B'0~.., ;i:&":\~~~ ~~~ . i~;'~1 ~U';:--~II Ii r\-- Ii. .. ,,- \itBi . ,.' '.J..' !'" ~ I ! , .!'.. .: ~ I .. \ ~'~ '., \ . I _ ..' ... v' ~ dil ~'".: '""'~. "" \'. ,J,tt.t . · ... ,.'!In '" \ ~~; II, (\ -, '~ lIU l....\. l. l. (\' _,' J i t "".,.. """ """ \' ~ ........~ 1i"1II. Cp\'lnf\~n' o...a,\I1\."\ \l11" (lil II \ .- .. -. !I -.=-- ~~\ \.. ~.. .. ".~4f1- ': \ '-_ ,~ :(~~~!t. ~ ~__ t'1,~ ~\ \ (. '~. ~~- ~ ,;,...; ,~.\.~ .,~ Ij1~i f.J8I~ ",~: :~.;;;'';' ;.;....,. _-lp~'. ! .- ......~ .... I ' . . ,d. :;'-~ e:::-: ' . _~ ~' ' .-::-:::1 ~;' - ~, ~.A~ : . w ~ ,-~ \~-_.I. ,.' rff' ~.~p.- ---let) 1 . d Q 9 _ t-1 .- F.'-= : \ \UiC~ ~.. I ~: r :; '. ~. .-.~ ~-~ . !i ".. 1\ Name of peve~opment/OMnet Locate the subj~ct ptOpettY on shade in the area. " _ 1\FF-~~ 1991 ?L1\NN~~G OEF1\F-TME~T 1\~1\nn~ppl ( 6 ) OWNER'S AUTHORIZATION Under the provisions for Voluntary Annexation, Florida Statutes require that a petition for annexation must bear the signatures of all owners of property in an area to be annexed. The authority authorizing a person other than the owner to sign such a petition must be attached to and accompany such petition. A {'\ (\C" 'f<=>--tt0Y7 ?rG J fl3-yl'''\ ~= ~ .:::::a...-f-fo-c.-.~c:tf ~+er scrulCe ti r<::.erYlcn r SIGNATURE OF OWNER(s) OF ECORD SIGNATURE OF APPLICANT II n c;, II v 00 c-C G Ie l.k:.s 2:""nc:.. . TYPE NAME OF OWNER ( s) TYPE NAME OF APPLI CANT .ff~? La..wy""~ytCC l~C. S REET ADDRESS STREET ADDRESS ~()1on &oc:..~" FL. 33~~b CI & STATE CITY & STATE TELEPHONE NUMBER TELEPHONE NUMBER FAX NUMBER FAX NUMBER PLANNING DEPARTMENT - APRIL 1991 A: AnnxAppl (7 ) APPLICANT'S CERTIFICATION (I) (We) affirm and certify that (I) (We) understand and will comply with the provisions and regulations of Boynton Beach, Florida Zoning Code. (I) (We) further certify that the above statements or diagrams made on any paper or plans submitted herewith are true to the best of (my) (our) knowledge and belief. Further (I) (We) understand that this application, attachments, and fees become part of the Official Records of Boynton Beach, Florida and are not returnable. APPLICANT IS: x.. OWner A n h~ k~ -h'Oor1 I1-J ro-"YYl / .Sc:~ 6- -f--fa-c..herC (>..Jc.. kr ~,vic ~ J rc.~ fV/Cl1 r SIGNATURE OF APPLICANT Optionee r 'Y70 I it.Jaodl (.:,->0 \J c. ~ In <=- TYPE NAME OF APPLICANT Lessee gOS3 4c.Jr~~ ~. STREET ADDRESS Agent I3c..YP7L Reo..c"- ,PI.- 33Y..]b CITY AND STATE . Contract Purchaser TELEPHONE NUMBER FAX NUMBER PLANNING DEPARTMENT - APRIL 1991 A: AnnxAppl ( 8 ) AFFIDAVIT STATE OF FLORIDA ) ) SS COUNTY OF PALM BEACH) Before me, the undersigned authority personally appeared , who being by me first duly sworn, on oath deposes and says: 1. That he is the fee simple owner of the following described property, to wit: (Give legal description) An/)c 'L"c--li?/Y1 ~Y'rO-'tV; , ,s~ o-+~J..d wQ--re.r ~~Tlr?<:::~ J ' r~ r c:.c:... /Y1 ~ '" 1-. (attach an additional page if insufficient space) 2. That he desires annexation to Boynton Beach, Florida. 3. That he has appointed to act as agent in his behalf to accomplish the above. s~<:::.. O-+~i,~ ~o-1f-r &ru ,c.~ W r~rYlC:.l?-r- (SIGNATUR OF OWNER) Affiant Sworn to and subscribed before me Notary Pyblic, State of Florida at Large My Commission Expires: PLANNING DEPARTMENT - APRIL 1991 A: AnnxAppl