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W W w J D 0 0 M 0 O r 03 WC KC 03 o -n -y 0 0 " 0 -C ~r 90 F 00 0 ZZ ~z 0 0 N D 0 ~c) A C/) ~0 M O o X P rn z N cn z A Drn rm CL < ~ 0 ;q u M co ITIZ -4 FO 8 m ;UD (A W ca n _ m Z , M O 00 ^ 3 CD 0 - ~ D v =3 CO) 0 ~ ,3o Drn CD v Z D p m ~m Ox 0- r . rn Z> D n X ~m M 'n rn M c Z M a~0; o - 0 C1 M. m r 0 0 5. `N Z Z m o e m C3 o ;U o ;U DZ M " y nm D z 9 m m -0 n N v D > 0Z ° o y -I G 0 z m D Z M w W 0 Ot A 0 0 0' X 0 z G N C: z D 3 m m N 0 0 C 0 z C: 0 3 m0:,-' w a 3 cn m C n ( m ' 3 O Nv O O IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company Use: BUILDING STREET ADDRESS (Including Apt., Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Policy Number 16311 NW. 41ST AVENUE CITY STATE ZIP CODE Company NAIC Number MIAMI GARDENS FL 33054 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner. COMMENTS ❑ Check here if attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. 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.) E2. The top of the bottom floor (including basement or enclosure) of the building is _ ft.(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. E3. For Building Diagrams 6-8 with openings (see page 7), the next higher floor or elevated floor (elevation b) of the building is _ ft.(m) in.(cm) above the highest adjacent grade. E4. The top of the platform of machinery and/or equipment servicing the building is _ft.(m)_in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade,. (Use natural grade, if available). E5. For Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or community-issued BFE) or Zone AO must sign here. 09 Z.4 OJ --0 0 PROPS TY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE 9 0Jr 78oo -X46 °-0&6-:; SIGNATURE _ / l ' [SATE TELE COMMENTS ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is ai:tliorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), 6 ' and G of this Elevation Certificate. Complete the applicable item(s) and sign below. G1. ❑ The information"in Sectiofi C-was taken from other documentation that. has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by stata or iocaf law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A C61m nity official ca;npl~c d section E for a building located in Zone A (without aFEMA-issued or community-issu ed BFE) or Zone AO. G3. ❑ The folloing mformatinh (Items rvG4-G9) is provided for community floodplain management purposes. G4. PERMIT NUMBED= G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY 411 ISSUED 7 isI has been ssued1or"L]'New Construction ❑ Substantial Improvement 14 ~ y as k g basement) of the building is: _ft.(m) Datum: G8 Elevate n of a~-built Idwest floor mcludin ~at the • G9 BFE or (m Zone AO) depth' f building s ite is: ft. flooding (m)_ Datum: oe' ,'yl;,lf a LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE