HomeMy WebLinkAbout34-2115-005-1030t 14
FINAL EI1E VATION CE RTIFICATE.
This ecrtiGcatc shall be cubmitted for compliance of I Ic3-3f to DERM Food Mafia Managemeat Program to remove rlNAL COMPLL~nON
HOLD Tfiis cett~flcate wilt not '!k accepted if all items are not completed
PROPERTY INFORMATION
(Me following information to be provided by contractor, property owner or agent.)
Folio # 3 0 - "LI - 00'5 - 16-30 (RIOT ACCEPTED WITHOUT FOLIO) i
Address "ciJ (i D- C~
, PRO ESS !f. Permit 9: ~5
New Construction 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 dctoc tod 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 corrxtions•requ'urd hereby shalt be
cause to issue a stop work order for the project.
Name: Dater
(print)
Phone I
(signature)
ELEVATION CERTIFICATE
This certificate Is not valid If any Items are altered or not completed.
Subdivision Name L; Arv AAG kCwfs Lot ~ Blk <; PB 44 PG I'(10
Community I
Suffix
Panel
Dar of FIRM
FIRM Zone B
a Flood
120635
`
Gt1~0
(I
9
~ Ft. NGVD
7,4
• 6
Using F> TvtA's Elevation Certificate instructions, indicate diagram found on Pages 5 and 6 that best desenlj= the subject building's rcfcr+ence
kwei t
LOWEST FLOOR ELEVATION (Top Reference kvcl)
LOWEST ADJACENT GRADE ELEVATION
GARAGE OR STORAGE FLOOR ELEVATION
~Q FT. N.G.V.D.
FT. N.G.V.D.
FT: N.G.V.D.
ELEVATION OF HIGHEST CROWN OF ROAD (Fronting Property) t FT. N . G . V . D .
A/C COMPRESSOR (Provide top elevation of supporting structure) 3 = FT . N . G V . D .
I hereby certify that the information on this certificate is true and correct to the best of my knowledge arid.b;:licl:
Date M.
Certifier's Name :
- 1-2- F5
Phone: -VA / (print)
Certifier's Signature
Certificate / PLS
This form has been approved by The Federal Emergency Management Agency (FP-MA) and may be used for flood insurance purposes-
Rev. May 18, 19951ELEVCERT.195