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OMB No. 1660-0008 <br /> ELEVATION CERTIFICATE Expiration Date: November 30,2018 <br /> 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 P.O. Route and Box No. Policy Number: <br /> 39165 9th avenue <br /> City State ZIP Code Company NAIC Number <br /> Zephyhills Florida 33542 <br /> SECTION G—COMMUNITY INFORMATION(OPTIONAL) <br /> The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete <br /> Sections A, B, C(or E),and G of this Elevation Certificate. Complete the applicable item(s)and sign below.Check the measurement <br /> used in Items G8—G10. In Puerto Rico only, enter meters. <br /> G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, <br /> engineer,or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation <br /> data in the Comments area below.) <br /> G2 ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) <br /> or Zone AO. <br /> G3. ❑ The following information(Items G4—G10)is provided for community floodplain management purposes. <br /> G4. Permit Number G5. Date Permit Issued G6. Date Certificate of <br /> Compliance/Occupancy Issued <br /> G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement <br /> G8. Elevation of as-built lowest floor(including basement) <br /> of the building: ❑ feet ❑ meters Datum <br /> G9. BFE or(in Zone AO)depth of flooding at the building site: ❑ feet ❑ meters Datum <br /> G10. Community's design flood elevation: ❑ feet ❑ meters Datum <br /> Local Official's Name Title <br /> Community Name Telephone <br /> Signature Date <br /> Comments(including type of equipment and location, per C2(e), if applicable) <br /> ❑ Check here if attachments. <br /> FEMA Form 086-0-33(7/15) Replaces all previous editions. Form Page 4 of 6 <br />