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IMPORTANT: In these spaces, copy the corresponding Information from Section A. I For Insurance Company Use: BUILDING STREET ADDRESS (including Apt., Unit. Suite, andlor Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy rrumoer CITY STATE ZIP C1 Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS 1_1 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 E3. /f 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 i t fL(m)1 ( lin.(cm) Lj above or LJ below (check one) the highest adjacent grade. E3. 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? JJ Yes' JJ No LJ 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 SIGNATURE DATE TELEPHONE COMMENTS 1_1 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 Q. and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. I -J 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. " A community official completed Section E for a building located in Zone A (without a FEMA -issued or community4ssued BFE) or Zone A7. G3. (_---j The-followir;g information (Items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT.ISSUED IG6. ISS DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY G7. This permit has been issued for. L_J New Construction L_ -J Substantial Improvement G8. Elevation of as -built low'�t flo{�r (including base�ynt Qf the building is: ft.(m) Datum: G9. BFE or {n Zone AO) de "iJeo(�1"Vkjp� tiQitldih_ IS iswork5 � ft.(m) Datum: LOCAL OFFICIAL'S NAME the Elevation Certificate and w TITLE - COMMUNITY NAME recommends TELEPHONE SIGNATURE L-1 does not recommend DATE final [si i rClYt7I- COMMENTS sy Date a ( 1 g 1 o"=