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r.vvaruva r-vva IMPORTANT: In these spaces, copy the corresponding information from Section A. Fri 1n¢urartce.Company UW.'. :• Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Aolicy Numbe r. 76.6244 Alii Drive; Units 3 ! 4 City Kailue-Kona State Hi ZIP Code 96740 Comwa NAIC•Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenvcompany, and (3) building owner. comments Elevation listed on C2.e) is for air conditioning units. Signature I Date 4. p 3 Z0� 06;4,"�'l""� , g © Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUI ) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFT', complete hems E1 -E5. It the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, @, and C. For Koms Et -E4, use natural grade, If available. Check the measurement used. In Puerto R'rco 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 adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawl space, or enclosure) is ❑ feet i] meter: ❑ above or ❑ below the HAG, b) Top of bottom floor (Including basement, crawl space, or enclosure) is ❑ feet EJ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-8 with permanent flood openings provided in Section A hems 8 and/or 9 (see page 8 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet O meters ❑ 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 0 meters ❑ above or E] 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 8, and E for Zone A (without a FEMA-isbued or community4ssued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are corr®ct to the best of my imowfedge. wrty Owner's or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments k here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) the local official who Is authorized by law or ordinance to administer the community s floodplain management ordinance can complete Sections A. B. C (or E), ind G of this Elevation Certificate, Complete the applicable item(s) and sign below. Check the measurement used in hems G8, and G9. 31. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or arehitectwho is authorized by law to certify elevation information, (indicate the source and date of the elevation data in the Comments area below.) 32. ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community4ssued BFE) or Zone AO. 33. ❑ The following information (Items G4.49.) is provided for community floodplain management purposes. G4, Permit Number GS. Date Permit Issued 06. Date Certificate Of CompliancetOccupancy Issued 37. This permit has been issued for: E] New Construction [3 Substantial Improvement W Elevation of as -built lowest floor (including basement) of the building: _❑ feet meters (PR) Oetum 69. SFE or (n Zone AO) depth of flooding at the building site: U feet D meters (PR) Datum Local Official's Name Title Community Name Telephone Signature Data C ents ❑ Check here it angchments