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I IMPORTANT: In these spaces, copy the corresponding infonnation from Section A For Insurarm Corl1Jany Use: BUILDING STREET ADDRESS (Induding Apt, Un~ Suite, andlor BIj,:J No.) OR P.O. ROUTE AND BOX NO. Poky Nurmer . 4843 SUZANNE ST. ------ CITY STATE ZIP CODE Coolpany NAIC Number ZEPHYRHILLS FL 33542 SECTION D . SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy !nth sides cl tllis Elevation Certificate for (1) OO'11munity offidal, (2) insuranoo agenVOO'11pany, and (3) building o.vner. COMMENTS 1). BASE FLOOD DETERMINATION BY CITY OF ZEPHYRHILLS BUILDING DEPARTMENT 2). AIR CONDITIONING UNIT IS WINDOW TYPE I NONE AT GROUND LEVEL o Check here if attachments SEC-mON E . BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) I For Zone AO and Zone A (withoot BFE), OO'11p1ete Items E1 through E4. ~ the Elevation Certificate is intended for use as supporting information for a LOMA Or LOMR-F, Section C must be oortlpleted. E1. Building Diagr<JT1 Number _(Select the building diagr<JT1 most similCJ' to the building for which this certificate is being ampIeted - see pages 6 and 7. If no diagrcrn croJrately . represents the building, provide a sketch or photograph.) E2. The top cl the bottbm floor (induding basement or et'ldc5ure) cl the building is _ ft.(m) _in.(an) 0 above or 0 beIa.v (check one) the highest adjaoont grade. (Use natural grade, Wa'failable). E3. For Building DiagrjrnS 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) cl the building is _ ft.(m) _in.(an) above the highest adjaoont grade. Complete iijems C3.h and C3.i on front of form. E4. The top cl the p1atbm cl machinery CJ'ldIor equipment savicing the building is _ ft.(m) _in.(an) 0 above or 0 beIaN (check one) the highest adjaoont grade. (Use natural grade, Wavcilable). E5. For Zone AO only:: ~ no flood depth number is available, is the top cl the bottom floor elevated in axordCllCe with the OO'11munity's floodplain management ordinCllCe? o Yes 0 No 0 UnkroMl. The local clficial must ca1ify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property o.vner Or o.vner's authorized representative who OO'11p1eles Sections A, B, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA~ssued or OO'11munity- issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are conoct 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 clficici who is lauthoriZed by law or ordinCllCe to administer the OO'11munity's floodplain management ordinCllCe can rompIele Sections A, B, C (or E), and G cl this Elevation Certificate. Complete tile applicable ijem(s) and sign beIa.v. G 1. 0 The inform~ in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or archiject who is authorized by state or local law to ca1ify elevation information. (Indicate the source and date of the elevation data in the Comments CJ'ea beIa.v.) G2. 0 A OO'11munity cff1dal ampIeted Section E for a building located in Zone A (without a FEMA~ssued or OO'11munity~ssued BFE) or Zone AO. G3. 0 The folloNing information (Items G4-G9) is provided for OO'11munity floexlplain management plJlJX)Ses. G4. PERMIT NU~R GS. DATE PERMIT ISSUED GG. DATE CERTIFICATE OF COtvRIANCEIOCCUPANCY ISSUED G7. This lXlffilit has beEIn issued for: 0 New Construction 0 Substantial Improvement G8. Elevation of as-bui~ IoNest floor (including basement) of the building is: G9. BFE or (in Zone AQ) depth of flooding at the building sije is: LOCAL OFFICIAL'S rlJAME COMMUNITY NAME I SIGNATURE _._ft.(m) _._ft.(m) Datum: Datum: COMMENTS --4 TITLE TELEPHONE DATE - ----i o Check here if attachments FEMA Form 81-3', Jlmuary 2003 Replaces all previous editions