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IMPORTANT: In lbeae spaces. copy the corre.pondlng InformatIon from Section A. Building S~I Addtws (includf'!9 foP!., Unil. Suite, anci/or Bldg. No.) or P.O. Route and Box No. ?O ~ 1 -#"::>-r. City y hi \\ ~ Slme k ZIP Code SECTION 0 - SURVEYOR, ENGINEER. OR ARCHITECT CERTlFICAnON (CONTINUED) ;F.~I';"ilI_Gompanv Use; . . - ~.. . -. ,ilJiJllf:C;Y'li,/t1~ Copy both sides oflhls Elevation Certificate for (1) oommunlty omelet, (2) insunll'lC9 agent/company, and (3) building owner. Cammen.s C~Cl; shot 01'\ top of' -Footev Signature ~ ~ Dete q ~ d9.- () 0 Check h if attachments SECTION E . BUILDING I!LEVATION INFORMATION (SURVEY NOT ftEQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (Without8FE), complete Items E1-E5. If tile Certificate 18 intended to support Il LOMA or LOMR-F request, complete Sections A. a, and C. For Items E 1-E4, use naluliII grade, if available. Check Che msesuntl1'lenl used. In Puerto Rico only, enter meters. E1. Provide elevation infonnation for lhe following and check tile appmpr1a1e boxes to show whether tha elevallon Is above or befaw the highest adjacent grade (HAGl8l1clllle lowltSladjacam grade (LAG). 0 al Top of botlom lIoor (including b88ement, aawl space, orenclosure)is_. _ 0 l\3et 0 meters 0 above or B balowthe HAG, b) Top of botlom 1I00r (Ino1udino basement, aawr space, or enclosure) Is _. _ feet 0 meters 0 above or b&low the LAG. E2. For Buildklg Oiagrsms 6-8 with pennanant flood openIngs provided I,.. Secllqn..A Items 8 j!J..d1or 9 (ees ~e 8 of instructions,. the nelCl higher floor (lII8Vatlon C2.b in lhed/s{lmms) oftlte bill/ling is _' _0 feel U malers U above or U below the HAG, E3. Allached garage (lop of slab) ill _' _ 0 feet 0 ~ers 0 ahave or 0 below the HAG, E4. Top of plalfonn of machinery and/or equipment servicing the buildJng Is _. _ 0 feel 0 metalS 0 above or 0 below the HAG. E5. Zone AO only: If no flood depth number Is avaDable. Is the top of the botIom Iocr elevat.d In accordance with the community's lloodplaln management ordiflence? 0 Yes 0 No 0 Unknown. The local otIiclal must certll'y this lnforma\lon In Section G. -./ SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTA.TIVE) CERnFlCAnON The property owner or owner's authorized representative who completes Sections A. B. anp E for Zone A (without a FEMA-laaued or community-issued ElFE) or Zone "'0 must sign here. The 5tat91l16t1fs in Sections A. B, and E a... comoct to the best of my knowledge. Properly Owner's or OWner's Authorized Represenlative's Name ' Addres$ City ~ Stale ZIP Code Signature Date Telephone Comments SECTION G . COMMUNllY INFORMAnON (OPTIONAL) The local official who Is authorized by law or ordlnanoe 10 administer Ihe community's floodplain management ordinance can oomplele Sections A, B, C (or E), and G of tt1is Elevalion Certillcate. Complete the applicable ilem(s) and 5Ign bolow. Check the mea6urement used in It'Ilma G8. and G9. G1. 0 TI1e information In Seclion C was laken from other documenlaUon that has been signed and sealed by a licensed surveyor, engineer, or arcf1itect who is authorized by law to certify elevation information. (Indicate the soules and date of the elevation data in !he Comments 8rea below.) G2. 0 A community official cOmpleted Section E fOr a building located In Zone A (wilhoul a FEMA-issued or communIty-issued BFEI or Zone AO. G3. 0 The following Informetlon (Items G4.-G9.) III provide<:! wr community floodplain management purposes. G4. Permit Number G5. Dale Permit Issued Ga. Date Certillcate Of Complienc:eJOocupancy Issued o Check here If attachment~ G 7. "hl s permit has been issu<<NI for: 0 New Construction 0 SUbstantial Improvement G8. elevation of as-buiitlowest !Ioor ((neluding be.&ement} of tile buDding: 89. BFE or (in 20ne AO) deptll or flooding at the buDdIng site: o feet 0 mealn. (PR) . Datum o feet 0 meters (PR) Datum Local Official's Name Tille Telephone Community Name SIgnature Dllte Corrmenls o Check here ff aUachmenls FEMA Form 81-31, February 2006 Replaces alf previous editions