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IMPORTANT: In these spaces, copy the corresponding information from Section A BUIlDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. 5th STREET For Insurance Company Use: Policy Number CITY ZEPHRYHILLS STATE ZIP CODE FL 33541 SECTION D . SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agenVcompany, and (3) building owner. COMMENTS : Company NAIC Number I I o Check here if attachments SECTION E. BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete ttems E1through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Builcing 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 building, provide a sketch or photograph.) E2. The top of the boIIom floor (induding basement or enclosure) of the building is _ ft(m) _in.(an) 0 above or 0 beIC7N (check one) the highest CKljacent grade. (Use nciura! grCKle, Wavailable). E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevcied floor (elevation b) of the building is _ ft(m) _in.( an) above the highest CKlja::ent grCKle. ~ items C3.h and C3.i on fioot of form. E4. The top of the p1atfonn of mcd1inery anc)'or equipment servicing the building is _ ft{m) _in.{an) 0 above or 0 below (check one) the highest CKlja::ent grade. (Use natural grCKle, Wavailable). E5. For Zone AO only: If no flood depth number is availatXe, is the top of the boIIom floor elevated in axordance with the community's floodplain management ordinance? o Yes 0 No 0 Unknown. The local official must certify this information in Section G. SECTION F. PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owners authorized representative who completes Saiions A, B, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA~ssued or community- issued BFE) or Zone AO must sign here. The statements in Sections A, 8, C. and E are conect to the best of my knowledge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS o Check here if attadlments SECTION G. COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by 1eM' or ordinarlce to CKlminister the community's fIoodplan ma1agement ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable nem(s) and sign beI(M1. G1. 0 The inforrnatim in Section C W"o:lS iaken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area beI(M1.) G2. 0 A communiiy official completed Section E for a building located in Zone A (without a FEMA-issued or community~ssued BFE) or Zone AO. G3. 0 The following information (neme; G4-G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER GS. DATE PERMIT ISSUED GS. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permtt has been issued for. 0 New Construction 0 Substaltiallmprovement Ga. Elevation of as-buitt lowest floor (including basement) of the building is: G9. BFE or (in Zone AO) depth of flooding at the building site is: LOCAL OFFICIAL'S NAME COMMUNITY NAME SIGNATURE COMMENTS _._ft.(m) _._ft.(m) Datum: Datum: TITLE TELEPHONE DATE FEMA Form 81-31, January 2003 o Check !lere if attachments Replaces all previous editions