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IMPORT ANT: In these spaces, copy the corresponding information from Section A For Insurance Company Use: BUILDING STREET ADDRESS (Including Apt, Unit, Suile, ancVorBkjg. No.) OR P.O. ROUTE AND BOX NO. Polic.y Number 5th STREET CITY STATE ZIP CODE Company NAIC Number ZEPHRYHILLS FL 33541 SECTION D. SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS 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 SFE), complete nems E1 through E4. ~ the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagrcm Number _(saect the building diagram most similar to the building for which this cellificate is being completed - see pages 6 and 7. ~ no diagram accurately represents the building, ~ a sketch or ~.) E2. The top dthe bottom floor Qncludng basement or erdosure) dthebuilding is _ft.(mLin.(an) 0 ctloveor 0 below (ched< one) the highest adjacent grade. (Use natural grade, Wavailable). E3. For Building Diagrlms6-8with openings (seepage 7), the next higher floor or elevated floor (elevation b) of the building is _ ft.(m) _in.(an) above the highest adjocent grade. CcrnpIete items C3.h and C3.i on front dform. E4. The top of the platform of mcd1inery arrl'or equiJl11el1! servicing the building is _ ft.(m) _in.(an) 0 above or 0 below (check one) the highest adjacent grade. (Use natural grade, Wavailable). E5. For Zone AO only: ~ no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? o Yes 0 No 0 UnkooNn. The kx:aI dIiciaI must certify this information in Section G. SECTION F . PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or ONI1eI's authorized representative who oompIetes Sections A, B, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA-issued or community- issued BFE) or Zone AO must sign here. The statements in Sections A a 4 and E are corred to the best of my knowfedge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE SIGNATURE DATE TELEPHONE COMMENTS o Check here if attachments SECTION G. COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, S, C (or E), and G of this Elevation Certificale. Complete the applicable ttem(s) and sign beICM'. G1. 0 The information in Section C was taken 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 below.) G2. 0 A community dlicial completed Section E for a building located in Zone A (without a FEMA~ssued or community-issued BFE) or Zone AO. G3. 0 The fdlowing information (Items G4-G9) is provided for community floodplain management purposes. G4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY ISSUED G7. This permit has been issued for: 0 New Construction 0 Substantial Improvement Ga. Bevation of $-buin IaNest floor (including basement) of the building is: G9. SFE 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 here if atlact'lmbnts Replaces all previous editions