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zr-, ANT: In th@se spaces, copy the corresponding Information from Section A. For Insurance Comnanv u..• State Zip SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTII both sides of this Elevation Certificate for (1) community official, (2) Insurance agentfcompany, end (3). building owner. nents Signature Date M— SECTION E -BUILDING ELEVATION INFORMATION (SURVEY NOT,REOUIRED) FOR ZONE AO AND ZOMBI 1vAT14rttrr ace For Zonas AO and A (without BFE), complete Items E1 -E6. If the Certificate is Intended to support a LOMA or LOMR-F request, complete Sections A, B, end C. For Items Et -E4, use natural grade, If available. Check the measurement used. In Puerto RICO only, enter motors. E1. Provide elevation Information for the following and Check the apPropdate 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 floor (including basement crawl space, or enclosure) Is _ feet 11 meters above or below the NAG. D) Top of Dollom floor (kcWtllnp basement, crawl space, or enclosure) Is _ _ ❑ fast ❑ meters � above or ® below the LAG. E2. For Building Diagrams 8-8 with permanent flood openings provided In Sectltp , Items 8 or 9 (see s 8 of Instructions), the next higher floor (elevation C2.D In the diagrams) of the building is . _ ❑leaf LJ meters L.J above or Lj below the HAG. E3. Attached garage (top of slab) Is _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform of machinery endlor equipment seMclng the building Is . _ fast C] meters [3 above or [-] below the HAG. ES. Zone nc only: If no flood depth number le avalleble, le the op w the bosom floor elevated in accordance with the communitys floodplain management ordinance? El Y84 ❑ No ❑ Unknown. The local official must certify this Information M Section G. occ r WN r-10KOPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owners authorized representatdre who completes Sections A. S. and E for Zone A (without a FEMA -Issued or community4acued BFE) or Zone AO. must sign here. The statements N Sections A, S. and E ere CWOdt to the best of my knowledge. Property Owners or Owners Authorized Representetiva•s Name ZIP • ••- ••�� .• ., .,nv . ekAnum a oy raw or ordinance to administer the community's floodplain management ordinance can complete Sections A, S. C (or E), and G of thle Elevason Certificate. Complete the applicable Item(s) and sign below. Check the measurement used In Items G8. end G9. Gt. ❑ The Information In Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is a Wrorized by law to ca" elevation Information. (indicate the source and date of the elevation data In the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or communiy-lasued BFE) or Zone AO. G3. ❑ The following information (Items G4.-Gg.) Is provided for community floodplain management purposes. G7. This permit has been Issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building: ❑ feet ❑ meters (PR) Datum G9. BFE or (in Zone AO) depjlhpfailgotirilifff&~ WWbiic Works • — ❑ feel ❑ meters (PR). Datum Local Official's Name Title Name ® recommends FEB 2 0 FEMA Form 81-31, February 2006 Replaces all