HomeMy Public PortalAboutButler Av_1701.pdfUS, DEPARYMENT CW HOMELAND SPOURnv ELEVATION CERTIFICATE
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�mpoirtmnt: Read the InMriuctions on pagies 1-9, �luMy d' " 1r
SECTION A — PROPERTY INFORMAIION FC)R KSUPRA W
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UCTION IB — FLOOD INSURANCE RATE MAP (FIRM) WFORMA71C)N
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SWON C — BWLMNG ELEVATION WFORMATION (SURVEYREQUIREE))
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SECTION 0 — SURVEYOR, ENGINEER,, OR ARCII�TECT CERTIFICATION
Fivis 00MMmum m to boo Wgnmd and NAWd by Oland Burvey, angneac on mumm ammed by waw, Mcb d,-e;wtgy .................. .
wilerinabon I c'oerwv Vl�ot Me hus C'erhfwatop �aptass roy hasl elrckars 1c) wtutprelf 6ft". dat& ava"Wo
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V �"heck hove 4 n1lanrmal its hc'ow,"ad �and �"uvvevoO El Yes No
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W.r!'L'N Lic"ense tqo"YqA!�r 3022
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ELEVATION CERTIFICATE, pane 2
IMPORTANT Ini Mov pacm, copy the cormspoindsliq frlformaflon from Section k F4)R:ANMff-�AUX G(AAFIANY
.hrilding Skeet Ad(ho,%:�4 10a,Waig Apt I JlW ',imlm mr�iu'lq)r RIPI�l re, t ,:, Cl, d 4ouw dnid Hox, Nq.,� Niul'Won
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BECVON 0 — SURVEYOR, EN!GNEEK ON ARCIMTECT CERTIFIC AT'ION ICONTMUED)
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S1ECT12!!EK- BUILDING_!.,N EWj!!?N INFORMATWN (9UkVEV NOT REOWREP40R ZONE AO AND ZONE A (WITHOUT
Fra 0:31,A cm 0 )NIRA B,
mOG KMm0Rm"mqeMmmmmS
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(,irmde dW A()y , and the lovowd mtqncliim W,push 0, AG?
a) rop ot bonown Once 0aWng Lmmom I umwwpdcx mm ammawa) m C I Woo [�j molm anom 0m (�j tx1ow lhe l, W:`,
t,, l �'op of Lrolon Nn�,�hW60 txh,000,01 W pt
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u yes [] No Unm,�mn � t�e! lip"m officwl qrlus� ��arqfly in seclton m.
SECTION F — P' TY'OWN'IER �01R OW'NER"S REPRES1ENTATWE) CERTIFICATION
nm W"W" amm or Owner m aullmarred V,Ompk-W% Sections A. B mi,,J E fm Zwm A pmn a FEMP,jss�gL,,f,3 (,q,
or Zome OW) nml sign mme 7he Wen=! 4, Wmm A& ond E &m cmmM ju Mo bmA d I, knw*mgv,
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SECVON G — COMMUNITY, W FORMA, 0N (0P710NALj,,,)
T M WON= Mm is, aufhoniiml R,)Y law cN mMmm" m mWWnWm%w 0maw*1 MmOlmn martagenmim A, 6, f(,rj 1,-),
011 this ElovmmjY Ctm4lk',k%'w COWWW Me qWAAW immm 010 mgn bewyv c3mr* Rm nmammmd umd uoWnm G& THDAn Pmno Rico m4, mm�r ,' mWjj6
•m wmmwmn m Snkin C wu Wen kam oWwr MxmwWWm MM Ims been agned and seWed by a kmoud sumeynt ungWlaer tv aumdam vwu�
is su=zed by low to e.4�rrti:N l4uMa'm Ofaimtgbm
02 U A mmnmily (mffi6,all Si C.lkAll N foU a I'mAkhng k:w:,4ed A Lore A Mi0mm a PFMA-mmued o; FIFE) (M 6 im A0
113" 3 W B10 fullomimmWimWon Mom C4- Owls lumbow Wm commmmay MMONM "Mimpmod Immm:5
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137 Firm panno has been lewd W CINew Conhwomi [I
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OR VOW W amWAI mem Hmn omfWog ommmem"s Is uwwmg leeq 0��eolm f)atmn
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If using the Elevation Certificate hoobtain NRPfluod insurance, affix at least 2 building photographs below according to the instructions
for |0am AO. Identify oU photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side
View." When app|icub|e, photographs must show the foundation with representative oxemp|*o of the flood openings or vamm, as
indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
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Front View 1-7-2015
I Rear View 1-7-2015
FEMA Form 086-0-33 (7/12) Replaces all previous editions,