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In these or HI 98778 . OR ARCHITECT CERTIFICATI[ Copy both sides of this Elevation Certificate for (1) community official. (2) Insurance agent/company. and (3) building owner. Comnle^ts�pVlA.TI't6\S JSizO f�STA'f3U$NE.D FSV lkDJrPfchl[]�e-iii iiAWA1\ SVi2J��' � ( PNS Q' _ %O FOUN A ' C-61LUMAIS L'AfS6y& �D,)AcE1iT Gr2ADE- ISTIILL VIDST' Sjr\tt-Ajz- rO $LzC p),kC"MAI5 Signature / Dale AO AND ZONE A For Zones AO and A (without BFE), complete Items E 1-E5. If the Certificate Is intended to support a LOMA or LOMR-F request complete Sections A, B, and C. For Items Et -E4, use natural grade, it available. Check the measurement used. In Puerto Roo only, order meters. Et. Provide elevatlon Information for the following and check the appropriate boxes to show whether the elevation Is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom Noor (including basement crawlspece, or enclosure) Is ` _ ❑feet ❑meters ❑above orx�below the HAG. re b) Top of bottom floor (including basement, cwlepaoe, or enclosure) Is _ _ ❑fest ❑meters []above or Hbekwv the LAG. E2. For Building Diagrams S-9 with permanent food openings provided In Sectio Itenre B 219 (see � 9-9 of Instructions), the next higher floor (elevation C2.b In the diagrams) of the building Is feet j_j metme LJ above or below the HAG. E3. Attached garage (top of slab) Is _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated In accordance with the community's floodplain management ordinance] ❑ Yes ❑ No ❑ Unknown. The local official must certify this information In Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes SeCtions A, B, and E for Zone A (Without a FEMA -Issued or community -Issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner's or Owner's Authorized Representative's Name Address City State ZIP Code _._....._ n ._ _,Com ..... ...........o..w .,. w.,,,,,,a.w um wort.., my a rwruuywm �nemegerrhen[ tnamence Can complete OeCDmhe A, IS, O (or E), and G of tta ElevatioCerdflcate. plete the applicable item(s) and sign below. Check the measurement used in Items GB and G9. G1. ❑ The Information in Section C was taken from other documentation that has been signed and reeled by a licensed surveyor, engineer, or architect who is authonzed by law to certify elevation Information. (Indicate the source arid date of Bre elevation data M Bre Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA -Issued or community -Issued BFE) or Zone AO. G3. ❑ The following information (Items G4 -G9) Is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued GS. Dote Certificate Of Compllanoe/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -bulk lowest floor (including basement) of the building ❑ feel ❑ meters (PR) Datum G9. BFE or (In Zone AO) depth of flooding at the building site ❑ feet ❑ meters (PR) Datum G10. Community's design flood elevation ❑ feet ❑ meters (PR) Datum Local Official's Name T! -,e Department of Puali;; Vdo1-Ls Tale Community Name Division hrs reviev:•ec Telephone Signature Oil Date � rc�cernlrfPnrt• Comments IJ cl...Ws rot recommend 1i--in`r app oval FEMA Form 81-31, Mar 09 i / Replaces all previous