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<br />.oRrANr: .. tIIeIe..... copy" CClItspOIIdIng hlbn., ..... SIdIDn A- <br />BUILDING STREET ADDRESS(RidQApt, Unt SUIIe, lIIib'BkIg. No.)~ P,O. ROOTEANJ BOX NO. <br /> <br />:F.it~~QE; ...... <br />.::~~." <br /> <br />CITY <br /> <br />STATE <br /> <br />ZPCOOE <br /> <br />::~:_~. <br /> <br />........i../....... , <br />. . <br /> <br />1Ii---... <br /> <br />SECTION D-SlJRVEYOR, ENGINEER, ORAACfII'ECT ~I.-..ATION (CON11NlJED) <br />Copy bah sides ctlhis EIevab1 Cerlli:ale for(1) ammnity aIIdS. (2) il1SUlllll2 ~.1Ild (3) txJikilg CfM1B'. <br />CCJ.M:NTS <br /> <br />Q Chad< here if alb:a:j IITIElI1lB <br />SECTION E - BlJI.DIG B.EVATION IR1RMTION (SURVEY NOT REQUIRED) FCRZOfENJ ANDZONEA(WRHOUT BFE) <br />Fa' ZoneAO andZooeA (vAlhout 8FE), CXlITI\i6lB Items E1lh1aJljl E4. ffth9Ele411ib1 Csttt/IaIe/s intend8db'usess ~ iJIbImti/onbra LOMA trLOMR-F. <br />SecIiaI Cll1JStbe~. <br />E1. 8uiIdng Ilagram tamer _(Select the ~ dapn roost sinla'to the Ilti1gtrwt1k:h tIis a!ftilk:ale is bei1g ~ -see PI9lS 6 aid 7. If no divan a:curaEly <br />represenIS the lliIlIIYJ, JmIide a sIBtI a JiK*lgIlI!ii-) <br />E2. The tq> d the tnDniloa(n:Iudng basement a l!I'ICkBJe) ctthe tukilJ is _ fl(m) _i1.(an) 0 abowt ex 0 beIcM (d1eck 008) the ~ l$8'lt ple. <br />E3. Fa' BuiIdng Dlagrans 6-8 'AiIh C4lriJgs (see page 7),lhe neJct hlgheriloaa eIrMEd 1Ioor (elevadat b) of the txiking is _ fl(m) _Il.(an) above the Ii!jlest ~ <br />ple. <br />E4. Fa' Zone AO CIlIy: If no fIoOO deplh numberis avaiaje, is the tq> ctthe IUIan liar eIBYalsd in ~ MIl the amnunily's ~ ITlallaQElII18I1t oo:hI1ce? <br />Dyes 0 No 0 lilIcncMn. The ileal aIlcialllUltarlytlis ilblllallal in SeclIon G. <br />SEC'TI)N F - ~I T 0IlIINER(OR CJIlINERS REPRESENTATNE)\il:KIn;;ATION <br />The IJ'l)peIty owner rt OM1efS aJthaized represenIatiYe who ca1J;EIes SedIa1sA. B, cn:I E fa Zone A (wiIhout a FEMA-lssued a<Xl1'llU1ity-ls BFE) a Zone AO must <br />sign here. <br /> <br />PR<PER1Y OWNER'S ~ QWIIER'SAlJ11iCAIZED REPRESENTA11VE'S NN.E <br />Al:JR:SS <br />SlGNAlURE <br /> <br />CITY <br />DATE <br /> <br />STATE <br />T8..EPHCJE <br /> <br />ZIP caE <br /> <br />CCJ.M:NTS <br /> <br />I::l Check here if alla:hrnents <br /> <br />SECTION G - COIM.rf'INFORIIATION (OPTIONAl.) <br /> <br />The kx:aI aIiciaI YiIo is aIlaized by Iav a adna1ce to lO1irister the aJTIt"IIJlily's bdpIain ITIaIllJQlllTlllIlt oohn:e ClI\ CQ'I'1JieIe SedIcnI A. B. C (a E), IIld G ct tis EIevatoo <br />CertIIIcale. ~ the ~ iIeIl'(s) IIld sign beIoN. <br />Gt 0 The h .fOIhakln in SeclIon C WlI! trilen fn:m olher doaJmenIaIia1 that has been signed lIld emImIed by a Iialnsed SlIIV8yOI', eIYiIiMB, a an::tiila who is auIhaiZBd by <br />stale ex toealavto cdy eIew.ib1 inbmalIon. (IndIcaIe the SOUIt9l1ld daledthe eIEMiia1 daa in the ConmenIs aea below.) <br />G2. 0 A CC!11JlIIIty aIidaI COO'lI*iBd SeclIon E fa a tliki1g Ioccied in Zone A (wiIhcut a FEMA-issued a CXlIllI1'lIJily BFE) a Zooe AO. <br />G3. 0 The ibftng ilfoo.lalkln (1tem8 G4-G9) is !JOVidlld forarmuily bdpIain IIBlagElI18i 1UJIllIIe8. <br /> <br />I G4.PERP.fTNlMER ., G5. OATEPERMTISS\.S) I G6. DATECERTFICA'TEa:ca.t'l.IAtaIOCClSSI.El <br /> <br />~. This pem1t has belli issued fa': 0 New CalIlIruc:tD1 0 SutIia1IiaI ~ . <br />Ga. EIevalon ctas-bliltk:MlestiloaQnci.Ki1gbasement)dthetXJiki'lg is: _' _fl(m) Dawn: <br />G9. 8FE a(il ZooeAO) depIl dfloodng at the IUkIng siIe is: _' _ fl(m) Dlium: <br /> <br />l.OC-'l.. CFFICW.'S tw.E TITlE <br /> <br />cor.M.NTY NAtA: <br />Sl3NATURE <br />Ca.u:NTS <br /> <br />'IB.EPtKJE <br />DATE <br /> <br />o Q\ed( here if atBtdTl8l1ls <br /> <br />I+UA Fnrm A1_'\1 AII~ QQ <br /> <br />RFPI Ar.F~ All PRF\Ilnll~ FnmnN.c; <br />