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ELEVATION IMPORTANT: In these spaces, copy the corresponding Information from Section A. FOR INSURANCE COMPANY USE Belong Street Address (including Apt.. Unit Suite, anchor Bldg. NO) or P.O. Route and Box No. Policy Number: 1357 Manors Street _ City Hila State HI ZIP Code 90720 Company NAC Number. SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agem/company, and (3) building owner. Comments Section As. The garage 1s fully open on the front and has partial openings on side. Date SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE). complete Items E1 E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B. and C. For Items Et{4, use natural grade, it available. Check the measurement used. In Puene Rico only, enter meters. Et. Provide elevation information for the follovwng and Check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement crawlspace, or enclosure) is _ _ ❑ feet ❑ meters ❑ above a ❑ below the HAG. b) Top of bottom floor (including basement craw/space, or enclosure) is _ _ ❑ feet ❑ meters ❑ above or ❑ below the iy G. E2, For Building Diagrams e-9 with permanent flood openings provided In Section A Items B and/or 9 (see pages 8-9 of Iretructior the next higher floor (elevation C2 to in the diagrams) titthe building is __ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is _ _ []feet ❑ meters ❑ above or ❑ beiow the HAG. E4. Top of platform of machinery ani equipment servicing the building is —_ ❑ feel ❑ meters ❑ shove or ❑ below the HAG. E5. Zone AO orly: If ne flood depth number is available. is the top of the bottom floor elevated in accordance win the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official meat cenify this information In Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner s auNorized representative who completes Sections A, B, and E for Zone A (without a FEMA -issued or commundy-issued BFE) or Zone AO most sign here. The statements in Sections A. B. and E are correct to the best of my knowledge. Property Owners or Owner a Authorized Representative a Name J C Address 1'1_ I 1\'1 /Lll ll Ili �t City 'j. C State 111 ZIP Code Cil' Signature Dale Telephone 'I g" a�{ur,,,.a- Comments tic hi I.U.��.,.� �IrA r JCC('. Check here d attachments. SECTION G - COMMUNITY INFORMATION (OPTIONAL) Ir—, arwlm..l.o m sumon:sa w ra ..—i saminumr the community's n x,d,min manwentern orinnovice con comaCm semorrn A. a. c car el. arw C of Ws Elevation Ceniflcate. Complete the applicable dem(s) and sign below. Check the measurement used In Items 38S310, In Puerto Rico only, enter meters. Gt. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a Idera nd surveyor, engineer, or architect who Is eufftonzed by law to mthly elevation information, (Indicate the source and date of the elevation dot. in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zane A (without a FEMA -issued or community -issued BFE) or Zone AO. G3. ❑ The followlrg information (Items G 10) Is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issuetl G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement 38. Elevation of as -built lowest floor (including basement) of the building. ❑feet ❑meters Datum_ Go, BFE or (in Zone AO) depth Of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's ciogn flood elevation ❑ feet ❑ meters Datum _ Local Official's Name Title Community Name Telephone Signature Date Comments ❑ Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions.