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Home My WebLink AboutBOA Agenda Pkt. 3-16-2009Date: March 10, 2009 To: Board of Adjustment members From: Barry Brown, Planning and Development Director RE: Board Meeting on March 16, 2009 The March agenda includes two items. The first is a request to extend the expiration date of a special exception. John Johanson of Tripple J Investments has requested a 12 month extension of Special Exception No. 05-15 that was granted on March 24, 2008 (see enclosed letter). According to Section 110-32, upon written request, the Board of Adjustment may extend the expiration date, without public hearing, by an additional 12 month period, provided the property owner demonstrates good cause. In his letter, Mr. Johanson cites current market conditions as cause for the requested extension. Staff considers Mr. Johanson's reason for the extension to be good cause and therefore recommends approval. The Board of Adjustment currently has two vacancies for alternate members and will soon need one additional full time member. Due to health concerns and other civic involvements, Jack Childs is making his seat available upon appointment of another board member. Enclosed are three Applications for Appointment to City Boards. Linda Brown, Douglas Raymond, and Leo Nicholas will be in attendance at the meeting and make themselves available for interview by the Board. Please feel free to call nye at 321 868-1223 or email brown -cape �cfl.rr.com if you have any questions or comment. Call to Order Roll Call NEW BUSINESS: City of Cape Canaveral OF ADJUSTMENT MEETING AGENDA 111 POLK AVENUE � 1x� 16, 2009 7:00 P.M. 1. Motion: Approval of Meeting Minutes - November 10, 2008. 2. Motion: Request to Extend the March 24th, 2009 Expiration Date, by an Additional 12 -month Period for Granted Special Exception No. 05- 15, to Allow Residential Use in the C-1 Zoning District (Harbor Heights West Subdivision) - Lot 3, Section 14, Township 24 South, Range 37 East - John Johanson, Managing Member for Tripple J Investments, LLC. 3. Interviews for New Board of Adjustment Members & Recommendations to City Council - Prospective Board Members Linda. Brown, Douglas Ray mond, and Leo Nicholas. OPEN DISCUSSION: p„rs,,7ar„t to Section 286.1015, Florida Statutes, the City hereby advises the public that: If a person decides to appeal any decision made by the Board of Adjustment with respect to any matter considered at this meeting, that person will need a record of the proceedings, and for such purpose that person may need to ensure that a verbatim record of the proceedings is made, which record includes the testimony and evidence upon which the appeal is to be based. This notice does not constitute consent by the City for the introduction or admission into evidence of othel-wise allowed by law. Persons with disabilities needina assistance to participate in any of these proceedings should contact the City C.lerles office at 868-1-221- (48) hours in advance of the meeting. This meeting may include the attendance of one or more members of the Cape Canaveral City Council and/or Quasi -Judicial Board members who mayor may not participate in Board discussions held at this public meeting. 105 Polk Avenue • Post Office Box 326 • Cape Canaveral, FL 32920-0326 Telephone: (321) 868-1222 • SUNCOM: 982-1222 . FAX: (321) 868-1247 www.myflorida.com/cape • email: ecapecanaveral@cfl.rr.com City of Cape Canaveral Board of Adjustment Meeting Minutes November 10, 2008 A Meeting of the City of Cape Canaveral Board of Adjustment was held on November 10, 2008 at the City Annex, 111 Polk Avenue, Cape Canaveral, Florida_.Assistant.City _Attorney, --Kate Latorre,-called-the meeting toorderat-7:00 P.M. The Secretary called the roll. MEMBERS PRESENT: Paula Collins Jack Childs John Bond OTHERS PRESENT: Susan Chapman Secretary Kate Latorre Assistant City Attorney Bea McNeely Ex officio Member Leo Nicholas Council Member Lamar Russell Planning & Zoning Board Member Barry Brown Planning & Development Director All persons giving testimony were sworn in by Assistant City Attorney, Kate Latorre. NEW BUSINESS Motion Re: Election of Chairperson and Vice Chairperson. Planning & Development Director, Barry Brown, announced that since the last meeting, Chairperson Earl McMillin and Vice Chairperson Connie McKone had resigned. Assistant City Attorney, Kate Latorre, opened the floor for nominations. Jack Childs nominated John Bond as Chairperson. Paula Collins seconded the nomination. There being no other nominations the floor was closed. Vote on the nomination to elect John Bond as Chairperson carried unanimously. Jack Childs nominated Paula Collins as Vice Chairperson. John Bond seconded the nomination. There being no other nominations the floor was closed. Vote on the nomination to elect Paula Collins as Vice Chairperson carried unanimously. Board of Adjustment Meeting Minutes November 10, 2008 Page 2 2. Motion Re: Approval of Meeting Minutes - August 11 2008 Motion_ by_Jack_.Childs,_seconded by Paula Collins, to -approve the meeting minutes of August 11, 2008. Vote on the motion carried unanimously. 3. Motion Re: Special Exception Request No. 08-06 to Construct a Single Family Residence in the C-1 Zoning District, Section 14 Township 94 South, Range 37 East, Lot A.02, Oak Lane - Bernard M Lennon Petitioner. Planning & Development Director, Barry Brown, advised that Bernie Lennon, Applicant, was requesting a special exception to construct a single family residence on Oak Lane; the Planning & Zoning Board recommended approval, with the condition that the City staff research and verify that the City had the necessary right-Of=way on Oak Lane-, according to the City Manager, Public Works department, and documents on file, the City did have the necessary right- of-way on Oak Lane; the right-of-way was 50 ft. in width, from N. Atlantic Avenue; the surrounding zoning was entirely C-1; the surrounding uses were residential, with multifamily to the North, a single family residence to the East, and vacant lots to the South and West of the subject property. Barry Brown explained that the only concern staff had was regarding the condition of the Oak Lane right-of-way. He advised that Oak Lane was a City road, which was unimproved with the exception of some asphalt that had been deposited over time, on a portion of the right-of-way. At this time, the City did not have any plans to construct Oak Lane. He further advised that at some point, in the future, Oak Lane would have to be constructed to City standards to Support additional residential construction and associated traffic. The road may be paved at the time that the Donald Haynes property, which is located at the West end of the road, was developed or upon replat of single family lots into townhouse lots. He noted that water and sewer was available; and staff recommended approval of the request in keeping with the nature of the surrounding area. Bernard Lennon, applicant, testified that he would start construction as soon as the Building permit was issued; the single family home would be 998 sq. ft. Chairperson, John Bond, advised that he reviewed the City's Future Land Use map and noted that mostly every use from north of Villages of Seaport to Central Boulevard was residential, therefore the requested use of the subject property would be more compatible with the surrounding properties, than if it was built for a principal light industrial use in the C-1 zoning district. Motion by Jack Childs, seconded by Paula Collins, to approve Request No. 08-06, to construct a single family residence on Lot A.02, Oak Lane. Vote on the motion carried unanimously. Board of Adjustment Meeting Minutes November 10, 2008 Page 3 4. Interview and Recommendation to City Council Re: Linda Brown Prospective Board Member. Planning & Development Director, Barry Brown, advised that Linda Brown was called out of town. This agenda item was postponed until the next meeting. OPEN DISCUSSION Jack Childs advised that he was contemplating on resigning from the Board due to his health condition. He advised that he would try to remain a member until a new member was appointed to the Board. There being no further business the meeting was adjourned at 7:17 p.m. Approved on this day of 2008. John Bond, Chairperson Susan L. Chapman, Secretary City of Cape Canaveral Board of Adjustment Respectfully request a 12 month extension on Special Exception Number 05-151, granted on March 24, 2008. 'he market conditions have changed in the time that the Special Exception was applied for and when it was finally granted. It is our hope that this situation will recover somewhat in the following year. Sincerely, Tripple J Investments, LLC D—, A " 1 ' John Johanson, Managing Member Sec. 110-32. Expiration of variance or spe- cial exception; abandonment. (a) Any variance or special exception approved by the board of adjustment pursuant to this article shall expire 12 months after the effective date of such approval unless a building permit based upon and incorporating the variance or special expiration is issued by the city within said time period. Upon written request of the property owner, the board of adjustment .may extend the expiration date, without public hearing, by an additional 12 -month period, provided the prop- erty owner demonstrates good cause for the ex- tension. Such request shall be submitted to the board of adjustment prior to the expiration of the first 12 -month period. In addition, if the afore- mentioned building pelllllt is timely issued, and the building permit subsequently expires and the subject development project is abandoned or dis- continued for a period of six months, the variance or special exception shall be deemed expired and null and void. (b) Thereafter, a variance or special exception shall expire and become null and void if the use granted thereunder is abandoned or otherwise ceases to exist for a period of 18 consecutive months. As used herein, abandoned shall mean that the applicant has gone out of business, let all business licenses lapse or has otherwise changed the use of the property in conformance with this Code. Once a variance or special exception has lapsed due to abandonment, the applicant must resubmit its request for variance or special excep- tion pursuant to this article. (Ord. No. 11-2005, § 2, 6-21-05) City of Cape Canaveral March 25, 2008 Tripple J Investments, LLC C/O John Johanson, Applicant P O Box 301 Cape Canaveral, FL 32920-0301 RE: Special Exception Request No. 05-15 to Construct Townhouses in the C-1 Zoning District (Harbor Heights West Subdivision) — Lot 3, Section 14, Township 24 South, Range 37 East — John Johanson, for Tripple J Investments, LLC, Petitioner. Dear Property Owner/Petitioner(s): Upon remand from the Brevard County Circuit Court, on March 24, 2008, the Board of Adjustment of the City of Cape Canaveral considered the Court's written decision and heard and considered additional evidence and testimony pertaining to Special Exception Request Number 05-15, made pursuant to section 110- 334(c) (10) of the Cape Canaveral Code of Ordinances ("City Code") to construct three (3) townhouses on the subject property, zoned C-1 Low Density Commercial. Based on the Court's decision and the additional testimony and evidence presented, the Board of Adjustment hereby grants your request with the following conditions and safeguards: • Petitioner shall construct no more than three (3) residential townhouses. Pursuant to Section 110-334 (c) (10), City Code, the requirements of the R-2 Medium Density Residential District shall apply to the residential construction on the subject property. Please be advised that pursuant to section 110-32 of the City Code, any special exception granted under Chapter 110 of the City Code shall expire 12 months after the effective date of such approval unless a building permit based upon and incorporating the special exception is issued by the City within said time period. Upon written request of the property owner, the board of adjustment may extend the expiration date, without public hearing by an additional 12 -month period, Provided the property owner demnngtraitec g00d ra,�ge fcr the extenSlvri. Such request shall be submitted to the board of adjustment prior to the expiration of the first 12 -month period. 105 Polk Avenue - Post Office Box 326 - Cape Canaveral, FL 32920-0326 Telephone: (321) 868-1222 - SUNCOM: 982-1222 - FAX: (32I) 868-1247 www.myflorida.com/cape - email: ccapecanaveral@cfl.rr.com Board of Adjustment Board Order Special Exception 05-15 March 25, 2008 Page 2 In addition, if the aforementioned building permit is timely issued, and the building permit subsequently expires and the subject development project is abandoned or discontinued for a period of six months, the special exception shall be deemed expired and null and void. Additionally, a special exception shall expire and become null and void if the use granted thereunder is abandoned or otherwise ceases to exist for a period of 18 consecutive months. "Abandoned" shall mean that the applicant has gone out of business, let all business licenses lapse or has otherwise changed the use of the property in conformance with the City Code, Once a special exception has lapsed due to abandonment, the applicant Must resubmit its special exception request pursuant to Chapter 110 of the City Code. Should there be a violation of any part of this approval; the special exception is subject to suspension or revocation according to the City Code. Sincerely, ?� Earl McMillin Chairperson Board of Adjustment /sic c: Anthony Garganese, Esq. Sheldon D. Stevens, Esq. STATE OF FLORJOA COUNTY OF BREdARO TAU 'a to carttfy that the foregoing is a trw and correct copy of Wlinam MY hand and official seal this COY Cprk - CHY,df Car,< Canaveral, FL Special Exception Request No. 05-15 To Allow Residential Use in the C-1 Zoning District (Harbor Heights West Subdivision) - Lot 3, Section 14, Township 24 South, Range 37 East - John Johanson, Managing Member for Tripple J Investments, LLC. Time Line of Events 1-25-06 Planning & Zoning Board recommended denial of the request. 2-13-06 Board of Adjustment tabled the request. 3-1 3_(16 RnarMi of A�ih ictment denied the request. 4-12-06 Petitioner filed an appeal. 9-14-07 Circuit court issued an order on the appeal. 3-24-08 Board of Adjustment reconsidered the request and granted the special exception based on the court overturning the previous decision of the board. 5-14-08 Planning & Zoning Board recommended approval of the preliminary replat to City Council. 6-3-08 City Council approved the preliminary replat. 9-24-08 Planning & Zoning Board recommended approval of the final replat to City Council. 10-7-08 City Council approved the final replat. 1-13-09 Petitioner requests time extension on special exception. N 59,50`16° E LOT 2, OF HARBOR HEIGHTS WEST (PLAT BOOK 48, PAGE 31) LOT 136 C HARBOR HEIG FIRST ADDITI (PIAT BOOK 14, PAGE SEA SHELL CA Y NORTH A Replat of Loi 3, NARBuK HEiGHiS �i -iI; Plat Book 48, Page 31, located in Section 14, Township ?4 South, Range 37 East, City of Cane Can(iveral Rre\iarrJ- rni m+\i �Inr�rin City of Cape Canaveral -- Member List CITY OF CAPE CANAVERAL IN ,.. a. News FAQ`S General Information Visitor Information Home Advisory Boards Agendas & Minutes City Departments C4 Directory City Elected Officials City Employment Library Links Volunteers Web Site Disclaimer In Advisory Boards: Beautification Board Board of Adjustment MEMBER LIST Business & Cultural Develpment Board Code Enforcement Board Community Appearance Board Construction Board of Adjustment and Appeals Library Board Planning and Zoning Board Recreation Board Page 1 of 1 s€AttoH Public Meetings 2008 State of the City Report New Marketing Video BOARD OF ADJUSTMENT 2 Alternate REVISED 1/14149 Member All Quasi -Judicial Board Members are Required Annually to File a Financial Disclosure Form. Forms are mailed directly to the Board Member's home and Vacancies it is the Board Member's responsibility to file-onAime as you will be subject to Penalty for not filing a timely report. E-mail: ccapecanaveral@cft.rr,com Board meets as needed on a Monday, 7:30 PM, Annex Per City Code 110-2(a) (5 Members) Three (3) Year Terms per City Code 2-171 (f) MEMBER Telephone APPT DATE TERM EXPIRES CHAIRPERSON JOHN BOND (H) 799-1810 09-02-08 09-01-11 8931 Lake Drive, Unit #402 Cape Ca Canaveral FL 32920 VICE -CHAIR PAULA COLLINS (H) 784-8256 09-19-06 10-01-09 8708 Bay Court 10-05-04 Cape Canaveral, FL 32920 10-07-03 10-01-00 09-15-98 10-03-95 JACK CHILDS 8062 Sunset Court (H) 799-1498 09-05-06 10-01-10 Cape Canaveral, FL 32920 10-03-06 10-16-07 DENNIS R. JENKINS 425 Pierce Avenue, Unit 405 (H186 -00184u i-"006-09 10-01-12 Ca2e Canaveral FL 32920 GEORGE J.SWEETMAN 7200 Polnsetta Avenue (H) 868-7750 01-06-09 10-01-12 Cape Canaveral. FL 32920 print'er48_gndiy.. vc mif.J" Footer Home I Advisory. Boards I Agendas _$. Minutes I City. Departments I City Directory I City_Etected Officials I City Employment I Library I Links I Volunteers I'Aeb Site.Disclaimer I News I FAOS I General. Information I Visitor. Information I Public Edeetings 120,38_State.of the City. Report I New .Nlarkefing.Video http://cityofcapecanaveral.org/index.asp?Type=B_BASIC&SEC= {BA67DE4E-CES3 -431... 3/11/2009 .17 JUL 15 2008 CITY OF CAPE CANAVERAL APPLICATION FOR APPOINTMENT TO CITY ADVISORY BO RD OR COMMITTEE Pursuant to Section 2-171, Cape Canaveral Gode City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee if that person has been convicted of a felony, unless their civil rights have been restored. Please complete the following in the space provided: A. GENERAL 1. Applicant Name: r Ad J�)A , 24,0W.) 2. Home Address: 3. Home Telephone: ��v�l- 7'7,7. 055 A r)ccul-ation• 7`i1ip� 5. Business Telephone: 611 L3c?/. * SIFd - 453 C. Business Address: • �40; ler(Adt nuu/, come B. ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. 1. Are you duly registered to vote in Brevard County? 2. Have you been a resident of the City of Cape Canaveral for 12 months or longer? 3a. Have you ever been convicted or found guilty, regardless of adjudication, of a felony in any jurisdiction? Any plea of nolo contendere (no contest) shall be considered a conviction for purposes of this question. 3h 4a. If yes to 3a, have your civil rights been restored? Do you presently serve on any other City of Cape Canaveral advisory board or committee? 4b. If yes to 4a, please list each: M_ (N)-2' 5. City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent t�.00 to a standard criminal background check before being 67116 appointed to a board or committee. Do you voluntarily initials consent to having a standard background check performed on you by the City of Cape Canaveral? (Y)(N) 6a. Are you related to a City of Cape Canaveral Council member by blood, adoption or marriage? (Y)(N) ✓ 6b. If yes to 6a, please provide name(s) of person(s) and relationship to you: C. INTERESTSIEXPERIENCE I. Briefl state your interest in �sl/erving on a�rC,/ity advisory board or committee: !✓e' G/1GP Td u i77� /f�l< 7� E'1JC'l on C' e3/7GL-_elZ 'iJ1u� t lnc° W /.v r.� . V 2. Briefly state any prior experiences in serving on any governmental boayd or committee: rUc"� 4/7_ _266C. .�✓�G�l vas 15"I Y 1177 �i� �Y i n A 3. Please list any specialized skills and training (e.g., architect, engineer, general contractor, etc.) that you feel help to qualify you for membership on the desired board or 4. In numerical sequence (1 = mast interested), please rank which advisory board or committee on which you wish to serve: a. Beautfcation Board b. Board of Adjustment* c. Business and Cultural Development Board d.,_ Code Enforcement Board* e. Community Appearance Board* f. Construction Board of Adjustment and Appeals* g. Library Board h. tib Planning and Zoning Board* L Recreation Board j. Other: *'Members of fhPsP hraardls am nnai in=H fn nmm�f�f� and ,frtg uy;t?? �Q SilPeri'!sC! of E1€L'tio,'7s a Financial Disclosure Form Upon appointment to said board and prier to u!, I of each year following the initial appointment while still a member of said boarcf_ D. STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race, gender and physical disabilities of board and committee members. Please check the appropriate boxes: RACE GENDER African-American Male Asian -American ✓ Female Hispanic -American Not Known Native American Caucasian DISABILITY Not Known Physically disabled YOU HEREBY REPRESENT TO THE CITY OF CAPE CANAVERAL, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF CAPE CANAVERAL HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-.326, FLORIDA STATUTES, AND THE FLORIDA "SUNSHINE LAW' [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LAWS. PLEASE NOTE: Initial appointment to any City board is subject to City Council approval following a brief interview before the City Council at a regularly scheduled meeting. Your application will remain effective for one year from the date of completion. If you should have any questions regarding the completion of this application, please contact the City Clerk's Office at (321) 868-1221. 19 Signature: Gate:(��l fL;i 61 Please return to: City of Cape Canaveral Office of the City Clerk 105 Polk Avenue Cape Canaveral, Florida 32920 �n� OCT 9 2008 CITY OF CAPE CANAVERAL APPLICATION IFOR APPOINTMENT TO CITY ADVISORY BOARD RCOMMITTEE Pursuant to Section 2-171, Cape Canaveral Code t' City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person frorn serving on a City Board or Committee if that person has been convicted of a felony, unless their civil rights have been restored. Please complete the following in the space provided: A. GENERAL 1. , Applicant Name: Vir U-6 k4g-'s Xal�e a AW 2. Home Address: — 3.. Home Telephone: 1. Are you duly registered to vote in Brevard County? 4. Occupation: _ kp—e 7— 1 Have you been a resident of the City of Cape Canaveral for 12 longer 5., Business Telephone: months or 6, Business Address: U. Have you ever been convicted or found guilty, regardless B. ELIGIBILITY The information provided in this section is for purposes of determining whether you are eligible to serve on a City advisory board or committee. z} 1. Are you duly registered to vote in Brevard County? (y)— Have you been a resident of the City of Cape Canaveral for 12 longer months or U. Have you ever been convicted or found guilty, regardless of adjudication, of a felony in any jurisdiction? Any plea of nolo contendere (no contest) shall be considered a conviction for purposes of this question. (Y)__ (N)!:!/ 3b, If yes to 3a, have your civil rights been restored? (Y)__ (N)_ 4a. Do you presently serve on any other City of Cape Canaveral advisory board or committee? (Y) _ (N)—Z 4b. If yes to 4a, please list each: S. City ordinance requires that all persons applying for�siz City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to a board or committee. Do you voluntarily initials consent to having a standard background check performed on you by the City of Cape Canaveral'? (Y)!� (N)! 6a. Are you related to a City of Cape Canaveral Council member, by blood, adoption or marriage? tab. If yes to 6a, please provide name(s) of person(s) and relationship to you: C. INTERESTSIEXPERJENCE 1. . Briefly state ;your interest in serving on a Ciiy,advisory board or committee: 2. Briefly stateepy prior experiences in serving on any governmental board or committee: 4219 v✓ �� 3. Please list any specialized skills and training (e.g., architect, engineer, general contractor, site.) that y committee: ou feel help to qualify you for membership on the desired board or /& D vs t"v s' , -�5, ,UEC c 1 •� 4. In numerical sequence (1 = most interested), please rank which advisory board or committee on which You wish to serve: a. Beautification Board Ia. Board of Adjustment* c. Business and Cultural Development Board d. Code Enforcement Board* e. Community Appearance Board* f. _ Construction Board of Adjustment and Appeals* g. Library, Board h. Planning and Zoning Board* Recreation Board j• Other. *Members of these boards are required to complete and file with Me Supervisor of Elections a Financial Disclosure Form upon appointment to said board and prior to July 9 of each year following the rmtial appointment while still a member of said board. D. STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State disclosing race, gander and physical disabilities of board and committee members. Please check the appropriate boxes: RACE GENDER - African American Male - Asian -American Female - HispanicAmerican NotKnown Native American Caucasian DISABILITY Not Known - PhysiWily disabled YOU HEREBY REPRESENT TO THE CITY OF CAPE CANAVERAL, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE TO THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF CAPE CANAVERAL HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 11112-3111-.326, FLORIDA STATUTES] AND THE FLORIDA "SUNSHINE LAW' [SECTION 286.011, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LAWS, PLEASE NOTE. Initial appointment to any City board Is subject to City Council approval following a brief interview before the City Council at a regularly scheduled meeting. • Your application wit remain effective for one year from the date of completion. • if you should have any questions regarding the completion of this application, please contact the City 's Office at (321) 868-1221. Signature: Date: -IZLI'Q -7 /Q Please return to: CRY of Cape Canaveral Office of the City Clerk 105 Polk Avenue Cape Canaveral, Florida 32920 CITY OF CAPE CANAVERAL APPLICATION FOR APPOINTMENT TO CITY ADVISORY BOARD OR COMMITTEE Pursuant to Section 2-171, Cape Canaveral Code City Code requires prospective and existing board members to fill out an application. City Code also prohibits a person from serving on a City Board or Committee K that person has been convicted of a felony, unless their civil rights have been restored. Please complete the following in the space provided: A. GENERAL I Applicant Name: Z_ e-0 A// 0 /_/0 1-,4-r 2- Home Address: 3. Home Telephone: f 2-1 — 2rP_? 4. Occupation: f__C--r7A_6- S. Business Telephone: 6. Business Address: B. ELIGIBILITY The information provided in, this section Is for purposes of determining whether you are eligible to serve on a -City advisory board or committee, 1. Are you duly registered to vote in Brevard County? 1,1<1 (Y). (N)_ 2. Have you been a resident of the City of Cape Canaveral for 12 months or longer? (Y). (N)_ 3a. Have you ever been convicted or -found guilty, regardless of adjudication, of a felony in any Jurisdiction? Any plea of nolo contendere (no contest) shall be considered a for conviction purposes of this question. 3b. If yes to 3a, have your civil rights been restored? (Y)-_ (N) 4a. Do you presently serve on any other City of Cape Canaveral advisory board or committee? 4b. If yes to 4a, Please list each; 5. City ordinance requires that all persons applying for a City advisory board or committee must voluntarily consent to a standard criminal background check before being appointed to, a board or committee. Do you voluntarily Initials consent to having a standard background check performed on you by the City of Cape Canaveral? (Y) (N)_ 6a. Are, you related to a City of Cape Canaveral Council Y I member by blood, adoption or marriage? (Y).— (N).. 6b. If yes to 6a, please provide names) of person(s) and relationship to you: C. INTERESTS11EXPERIENCE 1. Briefly state your interest in serving on a City advisory board or committee: .. . ............. .... .. 2. Briefly state any prior experiences in serving on any governmental board or committee. 3. Please list any specialized skills and training (e.g., architect engineer, general contractor, etc.) thatyou feel help to quality, you for membership on the desired board or committee: 6- 4. In numerical sequence (i = most interested), please rank which -advisory board or committee on which you wish to serve: a. Beautification Board b. Board of Adjustment* C. Business and Cultural Development Board d. Code Enforcement Board* e. Community Appearance Board* f. Construction Board of Adjustment and Appeals* !9- Library Board h. _ Planning and Zoning Board* L Recreation Board J. Other: *Members of these boards are inquired to complete and file with the Supervisor of Elections a Financial Disclosure Form upon appointment to said board and prior to July I of each year following the initial appointment while still a member of said board. D. STATE REPORTING REQUIREMENTS. Section 760.80, Florida Statutes, requires that the City annually submit a report to the Secretary of State, disclosing race, gender and physical disabilities of board and committee members. Please check the appropriate boxes: RACE GENDER — African-American Male Asian -American Female — Hispanic -American Not Known Native American — Caucasian DISABILITY Not Known Physically disabled YOU HEREBY REPRESENT TO THE CITY OF CAPE CANAVERAL, UNDER PENALTIES OF PERJURY, THAT THE INFORMATION PROVIDED HEREIN IS TRUE AND ACCURATE To THE BEST OF YOUR KNOWLEDGE, AND THE CITY OF CAPE CANAVERAL HAS THE RIGHT TO RELY ON THAT INFORMATION. YOU HEREBY ACKNOWLEDGE THE EXISTENCE OF THE CODE OF ETHICS FOR PUBLIC OFFICERS [SECTIONS 112.311-.326, FLORIDA STATUTES] AND THE FLORIDA SUNSHINE LAW, [SECTION 286.0111, FLORIDA STATUTES], WHICH MAY PERTAIN TO YOU IF YOU ARE APPOINTED TO A CITY ADVISORY BOARD OR COMMITTEE, AND IF APPOINTED, IT IS YOUR SOLE OBLIGATION AND DUTY TO COMPLY WITH SUCH LAWS. PLEASE NOTE: • Initial appointment to any City board Is subject to City Council approval following a brief interview before the City Council at a regularly scheduled meeting. • Your application will remain effective for one year from the date of completion. • If you should have any questions regarding the completion of this application, please contact the City Clerks Office at (321) 868-1221. Signature: Date. '�Z// 9 /5 s— Please return to: C14F Of Cape Canaveral Office of the City Clerk 106 Polk Avenue Cape Canaveral, Florida 32920