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IMPORTANT: In these spaces,copy the corresponding information from Section A. For Insurance Company Use: <br /> Building Street Address(including Apt.,Unit,Suite,and/or Bldg.No.)or .0.Route and Box No. Policy Number <br /> {i t A► l s , L L-c. sctSok N ,tJ�. 11412 <br /> City State ZIP Code Company NAIC Number <br /> - tL2 Nkt*UlIeffkl ha bakt 1(P. ti Li) 94-745 <br /> SECTION D-SURVEYOR,ENGINEER, OR ARCHITECT CERTIFICATION(CONTINUED) <br /> Copy both sides of this Elevation Certificate for(1)community official,(2)insurance agent/company,and(3)building owner. <br /> Comments ALe Pi -. 1 t•16. fisW psikelizr •==.11Q --t-czil <br /> Signature --VA t�/ <br /> Date i l <br /> 6 I �( o S . <br /> ❑ Check here if attachments <br /> SECTIO = <br />