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IMPORTANT: In these BUILDING STREET ADDF CITY the corresponding information from Section A. (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. A For Insurance Companv Use: SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) ^opy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. MMENTS I -I Check here if attachment, 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 E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. 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 top of the bottom floor (including basement or enclosure) of the building is 1_1-1 ft•(m)1-1_lin.(cm) 1_1 above or 1_1 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 I_I-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 _ floodplain management ordinance? 1_1 Yes 1_1 No f_1 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, 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 ADDRESS CITY STATE ZIP CODE NATURE DATE TELEPHONE COMMENTS I_I Check 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), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1.1 I The information in Section 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.) G2. 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. G3. IJ The following information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for: 1_1 New Construction 1_I Substantial Improvement G8. Elevation of as -built lowest floor (including basement) of the building is: _ft.(m)Datum: G9. BFE or (in Zone AO) depth of flooding at the building site is: The 5epartmen8.4*1A%&k Works LOCAL OFFICIAL'S NAME TITLE as revlewe TURE DATE of recom f 2" s,plfl _1 Check here if attachments =AAA Gnrm 01_11 AI Ir; 00 � p=PI Ar•CC AI I ODPWIni IC PnITIMIC