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• k:Opy both sides of this Elevation Certificate for (1) community official, (2) insurance agenUoompany, and (3) building owner. COMMENTS"-- ....._ For Zone AO and Zone A (without BFE), complete Items Et through E4. If ft Elevation Cert/fkcate is Intended for use as supporting information for a LOMA or LOUR -F. Section C must be oompfeted. E7. Building Diagram Number _ (Select the building diagram most similar to the building for which this certificate is being completed – see pages 8 and 7. If no diagram accurately represents the building, provide a sketch or pholograri) E2. The top of the bottom floor (Including basement or enclosure) of the building Is 1 1 1 ft -(m) I_L In•(cm) IJ above or L( belo (check one) the highest adjacent grade. E3. For Building Diagrams 8-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building Is I _I l R.(m) I I Iin.(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 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 FEMA4ssued or community -Issued BFE) or Zone AO must sign here. PROPERTY• • .,. • .a. - ADDREW CITY STATE dP*S11.E SIGNATURE TELEP—HQNE--- COMMENTS I Check here If attachmer SECTION O • COMMUNITY INFORMATION (OPTIONAO The local official who is authorized by law or ordinance to administer the communitys floodplain management ordinance cancomplete Sections A, B, C (or Q. and G of this Elevation Certificate. Complete the applicable Rem(s) and sign below. G1. U The information in Section C was taken from other documentation Ural has been signed and embossed by a licensed surveyor, engineer, or architect who Is authorized by stale or kcal law lo.certity elevation information. (Indicate the source and date of the elevation data In the Comments area below.) G2. Lj A community official completed Section E for a building located In Zone A (without a FEMA -issued or community -issued BFE) or Zone AO. 03: LI The following information (hems G4 -G9) is provided for community floodplain management purposes. G7. This parit has been issued for: IJ New Construction I._.I Substantial Improvement G8. Elevation of as-bullt lowest floor (including basement) of the building is: _ fL(m)Datum: G9. BFE or (In Zone AO) depth of flooding at the building site Is: �ft.(m)Datum: LOCAL OFFICJWS NWvDepartment of feubije Ween.• TRE COMMUNITY NAME engineering Division elan, reviewed TELEPk1pNE SIGNATURE 110 irywtl 1, Carr ee w. .,.�