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IMPORTANT: In these spaces, copy the corresponding information from Section A BUILDING STREET ADDRESS (Induding Apt, Unit Suite, andlorBklg. No.) OR P.O. ROUTE AND BOX NO. 5th STREET For Insurance Company Use: Policy Number CITY ZEPHRYHILlS STATE FL ZIP CODE 33541 : Company NAIC Number SECTION D . SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevafion Certificate for (1) community official, (2) insurance agenVcompany, 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 BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, SecIicr1 C must be completed. E1. Building 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 bolIan floor (inducting basement or enclosure) ci the building is _ ft.(m) _in.(em) 0 above or 0 bebN (check one) the highest aija::ent grade. (Use natural grade, ~ avalctlle). E3. For Building Diagrans 6-8 with openings (see paJe 7), the next higher floor or elevated floor (elevation b) of the building is _ ft.(m) _in.( em) above the highest aija::ent !,TcIde. CoolJIete items C3.h and C3.i on front of form. E4. The top of the platform of mochinery and/or equipment servidng the building is _ ft.(m) _in.(em) 0 above or 0 below (chEd< one) the highest aijCOlllt grade. (Use natural grade, ~ available). E5. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in cmxtlance with the community's floodplain management ordinance? Dyes 0 No 0 Unknown. The local olfK:ial must catify this infotmation in Section G. SECTION F . PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes SectiorIs A, B, C (Kerns 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 B, 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 attachments , SECTION G. COMMUNITY INFORMATION (OPTIONAL) The local offidal who is authorized by law or ordinance to aiminister the community's floodplain management ordinance can complete Sections A. S, C (or E), and G of this Elevafion Certificate. Complete the applicable item{s) and sign bebN. 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 catify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. 0 A co..nmunity official completed Section E for a building located in Zone A (without a FEMA~ssued or community~ssued BFE) or Zone AO. G3. 0 The following !rifoonatlon (Items G4-G9) is provided for community floodplain management purposes. G4. PERMIT NUWBER GS. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCEIOCCUPANCY ISSUED G7. This permit has been issued for. 0 New Construction 0 Substantial Improvement GB. 8evation of as-buiit lONest floor Qncluding 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 Cleek here if attachments . Replaces all previous editions