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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, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. I Policy Number —1 CITY STATE ZIP CQ Company NAIC Number SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenticompany, and (3) building owner. COMMENTS J_J Check here if attachments 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. 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 I" ft.(m) IIlin.(cm) LJ above or LJ below (check one) the highest adjacent grade. E3. For Zone AO only; no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? J_J Yes' J_J No J_J 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 FEMA4ssued or community -issued BFE) or Zone AO must sign here. ROPERTY 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 E), and G of this Elevation Certificate. Complete the applicable items) and sign below. G1. J_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. J_J 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. 1_1 The following information (items G4 -G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER 35. DATE PERMIT ISSUED -G6. CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED G7. This permit has been issued for: J_J New Construction II Substantial Improvement G8. Elevation of as -built Iestfloor (including basemenlg of the building is: _ ft.(m) Datum: G9. BFE or (in Zone AO) ti Rth OT i tth9&1IH� UrsitW9r _ ft.(m) Datum: LOCAL OFFICIAL'S NAM TITLE he Elevation Certificate and OMMUNITY NAME IR recommends TELEPHONE NATURE Lf Goes not recommend DATE fined approval COMMENTS By