18440 NE 30 AVEFEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067 -0077
NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002
ELEVATION CERTIFICATE
Read the instructions on panes 1 - 7.
SECTION A - PROPERTY OWNER INFORMATION I For Insurance Company Use:
BUILDINGnST)A�� DDRESS (InGI ding Apt., Unit, Suite,4ndVor Bldg. o. OR P.O. ROUTE AND BOX NO. Company NAIC Number
��r6J �Zff �Ei �7 envy
CITY ';'7 �`n STATE�j� 'e% _/ ZIP CODE
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) '
L 111 UUWLUNtl I UUC IVY I IVNAL) IlUK14UN I AL UA I UM: SOURCE: Li GPS (type):
or ##.;lit # °) i_( NAD 1927 �� NAD 1983 1 1 USGS Quad Map U Other.
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
IP COMMUNITY NAME & COMMMU14TY
r, rL
NUMBER
- ao63,�
I B2. COUNTY NAME
B3. STATE
/ael CY
A
B4. MAP AND PANEL
NUMBER
I B5. SUFFIX
B6. FIRM INDEX B7. FIRM PANEL
DATE EFFECTIVE/REVISED DATE
B8. FLOOD
I ZO (S
B9. BASE FLOOD ELEVATION(S)
(Zone AQ se depth of flooding)
B1 D. Indicate the source of the ase Flood Elevation (BFE) data or base flood depth entered in B9.
Ll FIS Profile JZFIRM 1J Community Det ined iJ Other (Describe):
B11. Indicate the elevation datum used for the BFE in B9: I_ NGVD 1929 IJ NAVD 1988 1_I Other (Describe): _
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? lJ Yes No
Designation Date:
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Building elevations are based on: LlConstruction Drawings' lJBuilding Under Construction' I_.— {Ftfiished Construction
'A new Elevation Certificate i be required when construction of the building is complete.
C2. 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.)
C3. Elevations — Zones Al -A30, AE, AH, A (with BFE), VE, V1 -V30, V (with BFE), AR, ARIA, AR/AE, AR/A1 -A30, AR/AH, AR/AD
Complete Items C3a -i below according to the building diagram specified in Item C2. State the datum used. If the datum is different from
the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion
calculation. Use th space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion.
Datum Conversio omments
Elev�lion r rence mark used /1 Does the elevation reference mark used appear on e FI ? LJ Yes L_1 No
Qua) Top of bottom floor (including basemen or enclosure) . L ft.(m)
❑ b) Top of next higher floor i Or _ fL(m) N 1
❑ c) Bottom of lowest horizontal structural member (V zones only) , ft.(m) S o
d) Attached garage (top of slab) ft.(m) E 2 ` r
❑ e) Lowest elevation of machinery and /or equipment u v\
servicing the building n /Gl . _ ft.(m) E
I31,1-owest adjacent grade (LAG) --2. 0 ft.(m)
g) Highest adjacent grade (HAG) T -7. —`5 ft.(m) \ I
❑ h) No. of permanent openings (flood vents) within 1 ft. above adjacenj grade n�G#
❑ ) Total area of all permanent openings (flood vents) in C3h sq. in. (sq. cm)
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information.
I certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
be punishable by fine or
" r-V toll /) V— �� a.vmrnrvi rvnnlc DELTA rs L1F'V7'r. , ,
C3 r•
Fd r* n
•�'" "I^' uJ«� ,/ / �_/ UA It '(/ I tLLPNUNt�a t% ✓�i3 _�9V S
FEMA o F�V I SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS