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ANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: City State ZIP Code Company NAIC Number Kamuela WMIAI�tt I%M �Ae D - OR both sides of this Elevation Certificate for (1) community official. (2) Insurance agent/oompany, and (3) building owner. Elevation of Rest room is 2746.79 Attachment shows the ocation of the building on the property. August 15, 2008 For Zones AO and A (without SFE), complete Items Et -E5. If the Certificate Is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items E1 -E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacer grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawl space, or enclosure) is �. ❑ feet ❑ meters ❑above or ® below the HAG. b) Top of bottom floor (including basement, crawl space, or enclosure) is _ _ ❑ feet ❑ meters bove or below the LAG. E2. For Building Diagrams 8-8 with permanent flood openings provided in Sect1QILA Items 86ff� R58 /or 9 (see a 8 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is . _ ❑ feet t..J meters E 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 and/or equipment servicing the building le _ C]feet C:] motors C]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 managem ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this Information in Section G. F - The property owner or owners authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -issued or community-lasued BF or Zone AO must sign here. The statements In Sections A, B, and E are correct to the best of my knowledge. Property Owners or Owners Authorized Representative's Name rase City State ZIP Code Signature Date Telephone wnmmnm i no local omciai who is autnonzed by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B. C (or E and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8. and G9. GI, ❑ The Information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect v is authorized by low to certify 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 community -issued BFE) or Zone AO. G3. ❑ The following Information (Items G4.-Gg.) is provided for community floodplain management purposes. Permit Number Date Permit G6. Date G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -butt lowest floor (including basement) of the building: Gg. BFE or (in Zone AO) depth of flooding at the, building site: Local Official's Name Title Community Name Telephone Signature kjWmenrs M ❑ feet ❑ meters (PR) Datum ❑ feet ❑ meters (PR) Datum Issued ❑ hack here if attachm -EMA Form 81-31, February 2006 Replaces all previous editi