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'/3P/2003 08:39 8089697842 BRILHANTE HI PAGE 03 ?%-2903 01040 PM PAUL9HyMURRAY 8089590355 P. 03 In these spaces,co...the corresponding Intonation from Section A. For Insurance Company Ute: �1 E `NG - R EETADDRESS.E (Including Suite,and/or Bldg,No.) •R P.O.ROU AND BOX NO, Policy Number P CITY i STATE , , ZIP CC 4..7 Z rtpany MAIC Number SECTION P.SURVEYOR,BNOINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate(or(1)community official,(2)Insurance agent/company, and(3)building owner. COMMENTS -- -- • • Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO and ZONE A(WITHOUT 8FE) f=ar Zone AO.and Zone A(without SFE),complete Nems E1 through E3. if the,Elevation Certificate is intended for use as supporlfnp inter;; tion fora LOMA or LOMR-F,Section C must be completed. siding 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 budding,provide a sketch or photograph.) E2,The top of the bottom floor(including basement or enclosure)of the building is ) I I fL(m)f I Iln,(cm) ( I above or G_-,)below (check one)the highest adjacent grade. 5.3. 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 `!�=drteln management ordinan ?Li Yes' No 1 Unknown. The'001 official must Cecil this information in Section Q, �� ia_I rte•ce SECTION F-PROPERTY OWNER(QR 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 SFE)or Zone AO must sign here. t PROPERTY OWNER'S OR Ovi R'S AU T�HQRIZS• PRESENTATIVE'S NAME ACORE-SS CITY STATE Za3 CODE Steri •711RE • TE T LEPNON COMNtl:N7S — .. .—.» • Check here If attachments SECTION G•COMMUNITY INFORMATION(OPTIONAL) Tilt loc.; official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete •c ?^ri A,8,C(or E),end G of this Elevation Certificate. Complete the applicable Item(s)Arid Sign bsidw. 01.LI The lnformetIon In Sedion C was taken from other document.Uon that has been signed and embossed by a licensee surveyor, engineer,or architect who is authorized by state or local law to certify elevation information. (Indicate the source end date of the elevation dale In the Comments area below.) L, A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-Issued BFE)or Zone A0. G3.1...j The following information(Items G4-G9)is provided for community floodplain management purposes. G4.PE MIT NUMBER G5. DATE PERMIT issuEP OS. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED f37,This permil has been issued for: Li New Construction Li Substantial Improvement of as-buil)lowest floor rnciuol (' np basement)of the building is; _ _N.(m)Datum: E'F (ir!Zone AO)depth of flooding at the building elle is: V.'.CA'.OFFICIAL'S NAME TITLE • MUNITY NAME - - • •. r11- • 0 .1.)• re "or s TELEPH• E '• • DATE fg recommends [) does not recommend fmai approval J ) Check here If attachments • . a< �, ni ir.nn By T. • >7r-ni Ar`FQ All n19r_ti/ins!C rnrnnatc Date `e-1$1k03