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HomeMy WebLinkAboutApplication & Supporting DocumentationHEARING BOARDS 444 SW 2nd Avenue, 7th Floor • Miami, Florida 33130 Telephone 305-416-2030 • Fax 305-416-2035 www.miamiqov.com/hearinq boards VARIANCE i0-ooes-Dv Welcome to Hearing Boards! This application is intended to serve as a guide in assisting you with our public hearing process. Please feel free to contact us at the number above, should you have any questions. The deadline to file the complete application with supporting documents is the first five working days of each month from 8:00 am until 3:00 pm, except on the fifth day, at 12:00 pm. The application submittal date is the date stamped by Hearing Boards' staff on this page. The responses to this application must be typed and signed in black ink. Please note that pursuant to Section 1304.2.2 of the Miami Zoning Ordinance, no application shall be deemed to have been filed unless and until the application shall have been completed. All pertinent and accurate information/documentation; i.e., the plans, reports, exhibits, shall be presented at the time of filing, in addition to the paid receipt. The applicant is responsible for the accuracy of the information contained in the application and all supporting materials. Should you wish, you could bring the materials to our office for review before the deadline to ensure completeness. You will be responsible, if needed, to bring an interpreter for the English language to any presentation before city boards, committees and the city commission. A valid power of attorney will be required if neither applicant or legal counsel representing the applicant execute the application or desire to make a presentation before city boards, committees and the city commission. All documents, reports, studies, exhibits (8'h x11") or other materials submitted during this process will be kept as part of the record. An additional fee to record Zoning Board resolutions will be charged, and it is determined contingent upon fees charged at the time of recordation by the Miami -Dade County Recorder's Office at 22 NW First Street, First Floor. Upon arrival, ask for a certified copy of the Zoning Board resolution. They will keep the original, but please have them mail it to us at the address above, and bring the certified copy to our office. Copies of City Commission resolutions/ordinances can be obtained at our website through the "Legislative Hub", or for certified copies, please contact the Office of the City Clerk at 305-250-5360 or at 3500 Pan American Drive. ORDINANCE NO. 11469, CODIFIED IN CHAPTER 2, ARTICLE VI OF THE CITY CODE STATES THAT ANY PERSON WHO RECEIVES COMPENSATION, REMUNERATION OR EXPENSES FOR CONDUCTING LOBBYING ACTIVITIES TO REGISTER AS A LOBBYIST WITH THE CITY CLERK, PRIOR TO ENGAGING IN LOBBYING ACTIVITIES BEFORE CITY STAFF, BOARDS, COMMITTEES AND THE CITY COMMISSION. A COPY OF SAID ORDINANCE IS AVAILABLE IN THE OFFICE OF THE CITY CLERK (MIAMI CITY HALL), LOCATED AT 3500 PAN AMERICAN DRIVE, MIAMI, FLORIDA, 33133. Ordinance No. 12918 states that each person or entity requesting approval, relief or other action from the City Commission or any of its boards, authorities, agencies, councils or committees regarding any issue, shall disclose at the commencement (or continuance) of the public hearing(s) on the issue, any consideration provided or committed, directly or on its behalf, for an agreement to support or withhold objection to the requested approval, relief or action. The Disclosure of Consideration Provided or Committed for Agreement to Support or Withhold Objection Affidavit included in this package must be submitted with the application. The applicant must, at the commencement of any public hearing on the issue, if there is any disclosure to report, read the disclosure into the record. Also, the applicant must supplement the affidavit if there is any new information or additional information to disclose. Applications given to customers do not constitute action from the City of Miami without plans review and written comments from the Office of Zoning. Rev. 12-16-08 Please refer to Article 19 of the Miami Zoning Ordinance for Variance information. 1. Applicant name(s): RICK ROSEN Subject property address(es) and folio number(s): 1796 South Bayshore Lane, Miami, FI 33133 Folio number - 0141150230330 2. One (1) original survey dated within six (6) months from the date of application prepared by a State of Florida registered land surveyor. 3. One (1) original 24x36" plan, signed and sealed by a State of Florida registered architect or engineer showing property boundaries and proposed structure(s), parking, landscaping, etc.; building elevations and dimensions and computations of lot area and building spacing. 4. Bring the original 24x36" plan to Hearing Boards to be stamped, dated and initialed by a designee and then by the following departments before the application is filed: a) Department of Public Works on the 8th Floor; b) Office of Zoning on the 4th Floor; c) Planning Department on the 3rd Floor. Note: If comments are generated by any of the above, you must return to the architect or engineer to have those comments incorporated into the plans, and you must begin #5 again. Plans are to be submitted to Zoning for first time review starting from the 8th through the 20th of each month. Zoning will not be accepting first-time review plans after the 20th day of the month. 5. After obtaining signatures from the above departments, two (2) 11x17" and one (1) 8Y2x11" copies of the original plan, in addition to the survey. 6. Original and current Zoning Referral and Zoning Write -Up signed by Office of Zoning designee. 7. The subject property(ies) cannot have any open code enforcement/lien violations, unless the request, if granted, would remedy the violation. 8. Copy of the lobbyist registration processed by the Office of the City Clerk, if applicable. 9. At least two photographs showing the entire property showing land and improvements. 10. A clear and legible copy of the recorded warranty deed and tax forms of the most current year showing the present owner(s) and legal description of the property. 11. A clear and legible copy of the subject property address(es) and legal description(s) on a separate sheet, labeled as "Exhibit A", to match with the current survey's legal description. 12. Affidavit of Authority to Act and the Disclosure of Ownership of all owners and contract purchasers, if applicable, of the subject property (see pages 5 and 6). 13. Original Disclosure of Consideration Provided or Committed for Agreement to Support or Withhold Objection Affidavit. 14. Certified list of owners of real estate within 500 feet of the subject property (see pages 7 and 8). 2 Rev. 12-16-08 15. For all corporations and partnerships indicated: a) Articles of Incorporation; b) Certificate from Tallahassee showing good standing, less than one (1) year old; c) Corporate Resolution or a Power of Attorney signed by the secretary of the Corporation authorizing the person who signed the application to do so; d) Non-profit organizations: A list of Board of Directors less than one (1) year old. 16. What is the acreage of the project/property site? 0.324 acres What is the purpose of this application/nature of proposed use? Storage area for miscellaneous items and boat supplies (not in compliance with current setback requirements). 17. Is the property within the boundaries of a historic site, historic district or archeological zone? Please contact the Planning Department on the 3`d Floor for information. No 18. Is the property within the boundaries of an Environmental Preservation District? Please contact the Planning Department on the 3`d Floor for information. No 19. In support of the application, please supply the following evidence, on the point enumerated in Section 1903 of the Miami Zoning Ordinance. Note: This application will not be accepted unless items (a) through (f) below are complete. Please list evidence to be produced and use additional sheets, if applicable. (a) Special conditions and circumstances exist which are peculiar to the land, structure, or building involved and which are not applicable to other lands, structures, or buildings in the same zoning district. ❑ No. CYes. The project is a remodeling and addition to an existing house built in 1956 before the NCD-3 portion of the code was written and therefore it does not meet the side setback requirements stated in the current zoning code. (b) The special conditions and circumstances do not result from actions of the petitioner. ❑ No. OYes. As seen on the original tax card, a building permit for its construction was issued in 1956 before the current zoning code was written. (c) Literal interpretation of the provisions of the Zoning Ordinance would deprive the applicant of rights commonly enjoyed by other properties in the same zoning district under the terms of the Zoning Ordinance and would work unnecessary and undue hardships on the petitioner. ❑ No. 6Yes. The original house has a smaller footprint and floor area than that allowed by the current zoning code for a lot of that size, leaving little space for much needed storage. We feel that the proposed placement of the 112 SQ. FT. storage addition is the least evasive and most respectful of the original design. (d) Granting the Variance requested will not confer on the petitioner that special privilege that is denied by the Zoni g Ordinance to other lands, buildings, or structures in the same zoning district. CI No. OYes. Even with the proposed addition the project is considerably under the allowed floor area ratio and building footprint, and it also maintains 5-foot side setback after the storage area is built. 3 Rev. 12-16-08 (e) The Variance, if granted, is the minimum Variani,e that will make possible the reasonable use of the land, building or structure. ❑ No. L Yes. The proposed addition adheres by all other zoning requirements including front and rear setbacks, floor area ratio, building footprint, green space, and parking. (f) The grant of the Variance will be in harmony with the general intent and purpose of the Zoning Ordinance, and will not/be injurious to the neighborhood, or otherwise detrimental to the public welfare. ❑ No. a Yes. The allowed addition by the variance is minimally evasive and does not compromise the original architectural character of the house. Moreover, the overall footprint remains well within code and is consistent with neighboring properties and thus we feel that it is a reasonable petition. 20. Cost of processing, according to Section 62-156 of the Miami City Code*: a. CS, PR, R-1, R-2, (Single -Family and Duplex Residential uses) $ 250.00 b. Piers, docks, wharves and the like, for each Variance from the ordinance, per lineal foot $ 45.00 Minimum $ 700.00 c. All applications for Variances relating to the same structure shall be assessed a single fee to be calculated per square foot of gross floor area of the proposed structure or addition, based upon the definition of gross floor area found in Section 2502 of Zoning Ordinance $ .10 Minimum $ 650.00 Application for Variance as a result of a change in approved plans or as a result of a violation notice shall be charged an additional fee, per Variance: a. CS, PR, R-1, R-2 b. All other residential districts c. All nonresidential districts d. Extension of time for Variance Public hearing and public meeting mail notice fees, including cost of handling and mailing per notice $ 250.00 $ 450.00 $ 550.00 $ 500.00 $ 3.50 Surcharge equal to applicable fee from items above, not to exceed eight hundred dollars (800.00), except from agencies of the City; such surcharge to be refunded to the applicant if there is no appeal by the applicant or from a property owner within five hundred (500) feet of the subject property. *Pursuant to Ordinance 12719, all planning and zoning fees in excess of $25, 000.00, shall be paid in the form of a certified check, cashier's check, or money order. 4 Rev. 12-16-08 Signature Name Rick Rosen Telephone (305) 606-6834 412. M � 441ra- A - g- Mailing Add ress.4 8e theme ,re -LAM C aUcs a FL 551511 Miami, 11-33433- E-mail rrosen@higcapital.com STATE OF FLORIDA -- COUNTY OF MIAMI-DADE The foregoing,s ackn• !edged before me this /3 day of J/, l y 20 /b , by ''C — / O.Sc,✓ / J who is a(n) individual/ agent/corporation of 1 G CA ► A -A- a(n) individual/partnership/corporation. He/She is personally knoto me or who has produced (?ecgonally knows,/ as identification and who did (did not) take an oath. 5 Rev. 12-16-08 AFFIDAVIT OF AUTHORITY TO ACT Before me this day, the undersigned personally appeared Rick Rosen , who being by me first deposes and says: 1. That he/she is the owner or the legal representative of the owner, submitting the public hearing application as required by the Code of the City of Miami, Florida, affecting the real property located in the City of Miami, as listed on the foregoing pages. 2. That all owners who he/she represents, if any, have given his/her full and complete permission for him/her to act in his/her behalf for the change or modification of a classification or regulation of zoning as set out in the foregoing petition, including or ❑ not including responses to day to day staff inquires. 3. That the foregoing and following pages are part of this affidavit and contain the current names, mailing addresses, telephone numbers and legal descriptions of the real property of which he/she is the owner or legal representative. 4. That the facts, as represented in the application and documents submitted in conjunction with this affidavit, are true and correct. Further Affiant sayeth not. \ 9O Qr\ Applicant(s) Name Applicant(s) Sig a ure STATE OF FLORIDA -- COUNTY OF MIAMI-DADE The foregoing was acknowledged before me this / 3 day of c) tl/y 20 /D , by R,ek rRe3. �/ l who is a(n) individuaagent/corporation of ///a ; -M/ a(n) individuallpartners ip/corporation. He/She is personal! knciWrt to me or who has produceqLjj is,,,i4dykno, w as identification and who did (did not) take an oath. (Stamp) ummimilibauxime uaosE.: 3 Yew« wwor+M *Mild to i - o�y MU$ON Mi3NV 311Nd1Or ure Rev. I 2-16-08 DISCLOSURE OF OWNERSHIP List the owner(s) of the subject property and percentage of ownership. Note: The Miami City Code requires disclosure of all parties having a financial interest, either direct or indirect, with respect to a presentation, request or petition. Accordingly, disclosure of shareholders of corporations, beneficiaries of trusts, and/or any other interested parties, together with their address(es) and proportionate interest are required. Please supply additional lists, if necessary. Owner's Name(es) Rick Rosen Percentage of Ownership 100% Subject Property Address(es) 1796 South Bayshore Lane, Miami FL 33133 2. List all street address(es) and legal description(s) of any property located within 500 feet of the subject property owned by any and all parties listed in question #1 above. Please supply additional lists, if necessary. Street Address(es): Legal Description(s): None oscZI Owner(s) or Attorney Name Owner(s) or Attorney Signature STATE OF FLORIDA -- COUNTY OF MIAMI-DADE The foregoinvas ac owledged before me this /2 day of jt,/ 20 /D , by /'iirk o,. /) who is a(n) individualiartne1agent!corporation of /4 /(' C0;4-i/ a(n) individual/partnership/corporation. He/She is personally known to me or who has producedrso„4 f(„o,,,r) as identification and who did (did not) take an oath. ture 7 Rev. 12-16-08 EXHIBIT A Property Address: 1796 South Bayshore Lane, Miami, FL 33133 Legal Description: LOT 10 AND THE NORTHEASTERLY 3/5TH OF LOT 11, BLOCK 3, FAIRHAVEN AMENDED, according to the plat thereof, as recorded in Plat Book 8, Page 120 of the Public Records of MIAMI-DADE County, Florida. TOGETHER WITH PARCEL "A" Being the land Tying southeasterly of and adjoining LOT 10 AND THE NORTHEASTERLY 3/5TH OF LOT 11, BLOCK 3, lying between the easterly extension of the northerly line of said LOT 10 and the easterly extension of the southerly line of said NORTHEASTERLY 3/5TH OF LOT 11, FAIRHAVEN AMENDED, according to the plat thereof, as recorded in Plat Book 8, Page 120 of the Public Records of MIAMI-DADE County, Florida, being more particularly described as follows: BEGIN at the northwest corner of said LOT 10, BLOCK 3, THENCE SOUTH 60 degrees, 00 minutes, 00 seconds East, 21.22 feet to the seaward face of an existing seawall; THENCE SOUTH 33 degrees 23 minutes 38 seconds WEST, along the seaward face of the existing seawall, 80.41 feet; THENCE NORTH 61 degrees 48 minutes 58 seconds WEST, continuing along said seawall, a distance of 3.09 feet; THENCE SOUTH 74 degrees 49 minutes 06 seconds WEST, continuing along said seawall, a distance of 1.24 feet to its intersection with the easterly extension of the southeasterly line of said NORTHEASTERLY 3/5TH OF LOT 11, THENCE NORTH 55 degrees 32 minutes 53 seconds WEST, a distance of 15.67 feet to the southeast corner of said NORTHEASTERLY 3/5TH OF LOT 11; said corner being on the curve of the easterly line of said LOT 10 and said NORTHEASTERLY 3/5TH OF LOT 11; thence northeasterly along the arc of said curve, having a radius of 1029.60 feet, a central angle of 4 degrees 27 minutes 07", for an arc distance of 80.00 feet back to the POINT OF BEGINNING. 111111111111111111111111111111111111111111111 This instrument prepared by: Randy M. Goldberg, Esquire 1101 SW 71st Avenue Ft. Lauderdale, FL 33317 954-584-6324 c-FN C)CI8 RO '9 a, 6.2; OR P. k 26320 P9 r.; 0891 - 892; i 2P i s RECORDED 04/1 J 00 10 57, :t 6 DEED DOf: TAX 0.60 HARVEY RUVIHr CLERK. OF COURT NI.ANI-LADE C0UHTYr FLORIDA PERSONAL REPRESENTATIVE'S DEED BY THIS DEED made this / day of February 2008, between RANDY M. GOLDBERG, J.D., whose post office address is 1101 SW 71ST AVENUE, PLANTATION, FL 33317, the duly qualified and acting personal representative of the Estate of FRANK L. CICHON, deceased, whose post office address was 1796 SOUTH BAYSHORE LANE, MIAMI, FL 33133, as Grantor; and RICK ROSEN, a n 0 man, whose post office address is 1796 SOUTH BAYSHORE LANE, M AMI, FL 33133 as Grantees. Grantor conveys to Grantee the following real property in MIAMI-DADE County, Florida: Lot 10, and the Northeasterly 3/5th of Lot 11, in Block 3, of FAIRHAVEN AMENDED, according to the plat thereof, as recorded in Plat Book 8, at Page 120, of the Public Records of Miami -Dade County, FL Property Appraiser Parcel No: 01-4115-023-0330 SUBJECT TO: Restrictions, limitations, easements, reservations of records and to all valid zoning ordinances and to taxes. GRANTOR COVENANTS with Grantee that Grantor has good right and lawful authority to sell and convey the property and warrants the title to the property for any acts of Grantor and will defend the title against the lawful claims of all persons claiming by, through, or under Grantor. IN WITNESS WHEREOF, Grantor has hereunto set Grantor's hand and seal the day and year first above written. OR BK 26320 PG 085A2 LAST PAGE PERSONAL REPRESENTATIVE'S DEED STATE OF RANDY li.—GOTDBERG, J.D., as Personal Represent-aTive of the Estate of FRANK L. CICHON COUNTY OFZ; -t",v`if/ I hereby certify that on this /J' day of, FEBRRiARY-2008, an officer duly authorized in the State of P2 , to take acknowledgements, personally appeared RANDY M. GOLDBERG, J.D. who is personally known to me, or produced as identification, and who acknowledged and executed the foregoing instrument. NOTARY PUBLIC My Commission expires: s VIVI le!.. NIC ",, cam►pD04E461s Expires 121312009 ®ended thru (800)432-4254 Florida Notary Assn., Inc This Instrument Prepared By: Randy M. Goldberg, Esquire 1101 S.W. 71 Avenue Plantation, FL 33317 111111111111111111111111111111111111111111111 CFN 2008R029396.9 OR Bk 26320 P'9s 0893 - 895; (31095) RECORDED 04/11/2008 10:57:16 DEED DOC TAX 0.60 HARVEY RUVIHr CLERK OF CQU:V NIAt1I-DADE I:QUHTYr FLORIDA WARRANTY DEED THIS WARRANTY DEED made the 3 day of FEBR ARY 2008 by SHANA L. CHIAPPONE (f/k/a SHANE L. CICHON) a married woman, whose post office address is joined by her husband- CHIAPPONE herein called the grantors, and RICK ROSEN, a 54Wt.. man whose mailing address is: 1796 SOUTH BAYSHORE LANE, MIAMI, FL 33133, herein called the grantees. (Wherever used herein the terms "grantor" and "grantee" include all the parties to this instrument and the heirs, legal representatives and assigns of individuals, and the successors and assigns of corporations) WITNESSETH: That the grantors, for and in consideration of the sum of Ten Dollars ($10.00) and other valuable considerations, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases, conveys and confirms unto the grantees, all that certain land situated in MIAMI-DADE COUNTY, FLORIDA, to - wit: Lot 10, and the Northeasterly 3/5th of Lot 11, in Block 3, of FAIRHAVEN AMENDED, according to the plat thereof, as recorded in Plat Book 8, at Page 120, of the Public Records of Miami -Dade County, FL Property Appraiser Parcel No: 01-4115-023-0330 Subject to easements, restrictions and reservations of record without hereby re -imposing same and to taxes for the year 2001 and thereafter. TOGETHER with all tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. TO HAVE AND TO HOLD, the same in fee simple forever. AND the grantors hereby covenants with said grantees that the grantors are lawfully seized of said land in fee simple; that the grantors have good right and lawful authority to sell and convey said land; that the grantors hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever; and that said land is free of all encumbrances, except taxes accruing subsequent to December 31, 2008. IN WITNESS WHEREOF, the said grantors have signed and sealed these presents the day and year first above written. Signed, sealed and delivered in our presence: ~SAANA L. CHIRP NE Print Name /s/ u Print Name STATE OF FLORIDA COUNTY OF $ 4y,f: The foregoing instrument was acknowledged before me this day of FEBRUARY 2008, by SHANA L. CHIAPPONE, who is personally known to me or who has produced as -- identification. Nov T y PUfLIC - STATE OF FLORIDA Notary Public "` '",, Randy Mark Goldberg My couutdssion expires: 4gComirission#DD636657 Expires, NPR. 29, 201 i Doman iZ{uwATLANTICBQN1 NGCO„INC. ut- �k 26320 PG 089 5 L.AST PAGE IN WITNESS WHEREOF, the said grantors have signed and sealed these presents the day and year first above written. Signed, sealed and delivered in our presence: Witnesses: /s/ Print Name STATE OF FLORIDA COUNTY OF j72if7nl The foregoing_ .instrument was acknowledged before me this :' ,' day of -FEHR 7 2008, by who is personally known to me or who has produced as identification. My commission expires: NOTARY p173UC - 7.ATZ OF FLORIDA Randy Mark Goldberg t=z Ccmiryssica DD63665/ Expires: APR. 29, 2011 BONBAD THFt13 hT M TIC BONDING CO., INC. 1 111111 11111 11111 11111 11111 11111 11111 1111 1111 This Instrument Prepared By: Randy M. Goldberg, Esquire 1101 S.W. 71 Avenue Plantation, FL 33317 FN 2(3C)E3R0198970 OR Bk 26320 Pss 0896 - 897; (2ass: RECORDED 04/11/2008 10:57:16 DEED DOC TAX 0.60 HARVEY RUVIN, CLERK OF CDURr MIAMI-DADE COUNTY, FLORIDA WARRANTY DEED Maran THIS WARRANTY DEED made the aO day of fEBRITART 2008 by MADELYN CICHON a single woman, whose post office address is `.i jvt, okhc Lioc,c G;, herein called the grantors, and RICK ROSEN, a sir,/ 16 man whose mailing address is: 1796 SOUTH BAYSHORE LANE, MIA I, FL 33133, herein called the grantees. (Wherever used herein the terms "grantor" and "grantee" include all the parties to this instrument and the heirs, legal representatives and assigns of individuals, and the successors and assigns of corporations) WITNESSETH: That the grantors, for and in consideration of the sum of Ten Dollars ($10.00) and other valuable considerations, receipt whereof is hereby acknowledged, hereby grants, bargains, sells, aliens, remises, releases, conveys and confirms unto the grantees, all that certain land situated in MIAMI-DADE COUNTY, FLORIDA, to -wit: Lot 10, and the Northeasterly 3/5th of Lot 11, in Block 3, of FAIRHAVEN AMENDED, according to the plat thereof, as recorded in Plat Book 8, at Page 120, of the Public Records of Miami -Dade County, FL Property Appraiser Parcel No: 01-4115-023-0330 Subject to easements, restrictions and reservations of record without hereby re -imposing same and to taxes for the year 2001 and thereafter. TOGETHER with all tenements, hereditaments and appurtenances thereto belonging or in anywise appertaining. TO HAVE AND TO HOLD, the same in fee simple forever. AND the grantors hereby covenants with said grantees that the grantors are lawfully seized of said land in fee simple; that the grantors have good right and lawful authority to sell and convey said land; that the grantors hereby fully warrants the title to said land and will defend the same against the lawful claims of all persons whomsoever; and that said land is free of all encumbrances, except taxes accruing subsequent to December 31, 2008. OR. Bk 26320 PG 0897 LAST PAGE IN WITNESS WHEREOF, the said grantors have signed and sealed these presents the day and year first above written. Signed, sealed and delivered in our presence: MADEL CICHON Witnesses: /s/ Print Name t /s/ Print Name STATE OF FLORIDA COUNTY OF The foregoi g,,,# s)rument was acknowledged before me this day of FEBRUARY 2008, by MADELYN CICHON, who is personally known to me or who has produced as identification. Nota Public) My commissio T S: NOTA1 V PUBLIC - s !.T OF M AZDA �h" Ra dy IIrk Gc;dberg h Com �siot� #DD636657 • { '.APR. 29, 2011 BONDED • •• �n Pires:MID Pwrrrl C BONDING CO., INC. CITY OFMIAMt DISCLOSURE OF CONSIDERATION PROVIDED OR COMMITTED FOR AGREEMENT TO SUPPORT OR WITHHOLD OBJECTION The City of Miami requires any person or entity requesting approval relief or other action from the City Commission or any of its boards, authorities, agencies, councils or committees, to disclose at the commencement (or continuance) of the hearing(s) on the issue, any consideration provided or committed, directly or on its behalf, to any entity or person for an agreement to support or withhold objection to the requested approval, relief or action. "Consideration" includes any gift, payment, contribution, donation, fee. commission, promise or grant of any money, property, service, credit or financial assistance of any kind or value, whether direct or implied, or any promise or agreement to provide any of the foregoing in the future. Individuals retained or employed by a principal as a lobbyist as defined in Sec. 2-653. and appearing before the City Commission or any of its boards, authorities, agencies, councils or committees solely in the capacity of a lobbyist and not as the applicant, or owners' legal representative are not required to fill out this form. \. ME: HOME ADDRESS: I LOMF. PHONE: (Firs( Name) (Middle) CIS (Last-Name) IGc o S- S \ocS \cv e.. (Address Lne 1) (Address Line 2) STATE: Florida ZIP: '33133 •2:,S9—�iyyL1 cll.,. PiK)\1::(3os) C0642 9 FAX: (3s) 3' -11337 EMAIL: ©S in �(1i.bCc.. f) �• Com RUSS1NFSS or :APPLICANT or -1NTITY NAME I31.SINESS ADDRESS: (Address Line 1) (Address Line 2) I. Please describe the issue for which you are seeking approval, relief or other action from the City Commission, board, authority, agency, council, or committee. Zgef uzS-1" ror Vat/'iaNGG. 7o 4 e SGiLf, tc ih 1 JL—3. 2. Has any consideration been provided or committed, directly or on your behalf, to any entity or person for an agreement to support or withhold objection to the requested approval, relief or action? ❑ YES NI NO If your answer to Question 2 is No, do not answer questions 3, 4 & 5 proceed to read and execute the Acknowledgment. If your answer to Question 2 is Yes, please answer questions 3, 4 & 5 and read and execute the Acknowledgement. Doc. No.:86543 3. Please provide the name, address and phone number of the person(s) or entities to whom consideration has been provided or committed. Name Address Phone a. b. c. * Additional names can be placed on a separate pile attached to this form. 4. Please describe the nature of the consideration. 5. Describe what is being requested in exchange for the consideration. AC'KNOWLEDGEMIENT OF COMPLIANCE 1 hereby acknowledge that it is unlawful to employ any device, scheme or artifice to circumvent the disclosure requirements of Ordinance 12918 and such circumvention shall be deemed a violation of the Ordinance; and that in addition to the criminal or civil penalties that may be imposed under the City Code, upon determination by the City Commission that the foregoing disclosure requirement was not fully and timely satisfied the following may occur: I. the application or order, as applicable, shall be deemed void without further force or effect; and 2. no application from any person or entity for the same issue shall be reviewed or considered by the applicable board(s) until expiration of a period of one year after the nullification of the application or order. PERSON SUBMITTING DIS('LOSI RI:: n Signature \ c-`-, jS �V1 Print Name Su urn To and subscribed ht'fi,rc' The ihi.s cXq <ko <4. June nMM . 204,0 The foregoing instl'ull ent 11u.\ CICAIn a fc'e(gc 1 before Inc' lei• g 1 T�SY • ltin, ha.,. produced <t' /t('llh11( 0ilr111 Ull<f Or i i 1,c1.11(4l1 h/it.it ll it. Ilk' ,1 itl 11 !]r7 did JO 110i !<lL' till t1U1. CARRIE M. MOSCOW NOTARY PUBLIC SLATE E OF FLORIDA _ : STATE OF FLORIDA CITY OF NIIAMI '.� Comm#DD97609f5 MY COMMISSION Notary EXPIRF.S:7 I11)201 H Oarrir M . 1,./10SC'ow IV' ?_ Pm! Name lfnclosuretrl Doi. No..R(541 Page 2