HomeMy WebLinkAbout34-2117-004-3840FINAL ELEVATION CERTIFICATE
This certificate. shall be submitted for compliance of I Ic3-3f to DERM Flood Plain Management Program to remove FINAL COMPLETI
HOLD
This cerlifzcate will not be accepted if all items are not completed
PROPERTY INFORMATION -
(The following information to be provided by contractor, property owner or agent.)
Folio # 3 0 - - ~9D - _(NOT ACCEPTED WITHOUT FOLIO)
Address 3 7 k/ 1L 5 S fil 14F~ PROCESS G d n b emit u:9 a9G~ ~
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 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 hereby shall be
cause to issue a stop work order for the project.
Name: -Date:
(print)
Phone k
(signature)
ELEVATION CERTIFICATE
This certificate is not valid if any items are altered or not completed. Jr , 7.91) 5 • 1 2 O of u' ° Z _4-- 7, Z Z
`
Subdivision Name V jE (-~~W
_,5 LotJ PB .33I PG 37
Community #
Suffix
Panel #
Date of FIRM
FIRM Zone
Base Flood
120635
0080
M 2ilgq~
X
^'lR Ft. NGVD
Using FEMA's Elevation Certificate instructions, indicate diagram found on Pages 5 and 6 that best describes the subject building's reference
level
LOWES'T' FLOOR ELEVATION (Top Reference level)
FT.
N . G . V . D .
LOWEST ADJACENT GRADE ELEVATION
S• 3 FT.
N.G.V.D.
GARAGE OR STORAGE FLOOR ELEVATION
A114 FT.
N.G.V.D.
ELEVATION OF HIGHEST CROWN OF ROAD (Fronting Property)..
FT.
N. G. V. D.
A/C COMPRESSOR (Provide top elevation of supporting structure)
1 J/A FT.
N . G . V . D .
I hereby certify that the information on this certificate is true and correct to the best of my knowledge and belief.
Date ! 7
Certifier's Name : Pq Gl ('C ~G G
Phone a: VOS) Q S Print
Certifier's Signature
Certificate # Al 7/
PLS
This form has been approved by The Federal Emergency Management Agency (FEMA) and may be used for flood insurance purposes-
Rev. May 18, 1995/ELEVCERT.195