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(IMPORTANT: In these spaces, copy the corresponding Information from Section A. For Insurance Company Use: BUILDING STREET ADDRESS (Including Apt.. Unit, Suite. and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number CITY STATE ZIP CODE Company NAIC Number SECTION D - SURVEYOR, ENGINEER. OR ARCHITECT CERTIFICATION ICONTINUE01 Wboth sides of this Elevation Certificate for (1) community official, (2) insurance agent/company. and (3) building owner. — 1_1 Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items Et through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. Et. Building Diagram Number _ (Select the building diagram most similar to the building for which this certificate is being completed — see pages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The lop of the bottom floor (including basement or enclosure) of the building is LI_I ftdm) I._Llin•(cm) 1_I above or IJ below (check one) the highest adjacent grade. E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is 1-1-1 ft•(m) I_I_lin.(cm) above the highest adjacent grade. E4. For Zone AO only. If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's No must 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. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME COMMENTS 11 Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) he local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete iections A, B. C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. 311. (_( The information in. Se"d1oh C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who Is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) '2. 1_1 A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. i3. 1_1 The following information (Items G4 -G9) is provided for community floodplain management purposes. ISSUED t7. This permit has been issued for: 1_1 New Constructionp I_I Substantial Improvement i8. Elevation of as -built lowest floor (including basement) of the building is: _ _ ft.(m)Dalum: i9. BFE or (in Zone AO) depth of flooding at the building site is: _ _ ft.(m)Dalum: LOCAL OFFICIAL'S NAME The Deparilmen?Public WORI; TITLE COMMUNITY NAME Engineering-Divis;en has Ieyielied TELEPHONE the Elevation Certificate and .,i ocoi Arte Ar r