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FINAL ELEVATION CERTIFICATE
ertificate shall be submitted for compliance of I lc3-3f to DERM Flood Plain Management Program to remove FINAL COMPLETION
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LCD This een Cate iff not be accepted Fall items are not completed s _0 7- 2~~
PROPERTY INFORMATION
(The following information to be provided by contractor, property owner or agent.)
Folio # : 3 0 --)-1 \ y -U'c-~ - 0060 MOT ACCEPTED wrmOUT F01.I01)
Address : 1000 N. W. 155 Lane
X New Construction
PROCESS X:C 9,116 Permit
Addition, Reconstruction or combination
I certify that the above information represents my best effort to interpret the data required. I understand that any work undertaken prior to
obtain a certificate of completion or occupancy will be at the PERMIT HOLDER'S RISK. The County will review the elevation data
submitted. Deficiencies detected by such review shall be corrected by the permit holder immediately and prior to further progressive work
being permitted to proceed. Failure to submit the elevation survey or certificate or failure to make said corrections required hemby shalt be
cause to issue a stop work order for the project.
Name:
(print)
Phone #
(signature)
ELEVATION CERTIFICATE
This certificate is not valid if any items are altered or not completed.
Subdivision Name "GOLDEN LAKES" Lot 4 Blk---- PB 96 PG 35
Community Suffix Panel , Date - of FIRM 11 FIRM Zone Base Flood
120635 8 J 11 0090 1 3/2/94 1I 11AE" I1 7 Ft. NGVD
1
Using FEMA's Elevation Certificate instructions, indicate diagram found on Pages 5 and 6 that best describes the subject building's reference
level 1
LOWEST FLOOR ELEVATION (Top Reference level) 7.55 FT. N . G . V . D .
LOWEST ADJACENT GRADE ELEVATION 7.0 FT.
N.G.V.D.
FT.
GARAGE OR STORAGE FLOOR'k tLEVATION n/a
N.G.V.D.
ELEVATION OF HIGHEST CROWN OF ROAD ~ro nting Property).. 6.73 FT.
N.G.V.D.
FT.'
A/C COMPRESSOR (Provide top elevation of supporting structure)-.
N.G.V.D
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I hereby cert
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Date 1 2/1 3/95~ ,
Alber 'o' o c
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s Name
Certifier
220-6397
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Phone#:
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Certifier's Signature
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. 3087 S
certificate r
This form has beta approved by The Federal Emergency Management Agency (FEMA) and may be used for flood insurance purposes-
Rev. May 18, 1995/EL.EVCERT.195
Date: