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223 BAYSIDE DRU.S. DEPARTMENT OF HOMELAND SECURITY FEDERAL EMERGENCY MANAGEMENT AGENCY :�'atNxnal_F7noc�lnsurance Pro�;ram uilding Owner's Name Nancy J. Bundy ELEVATION CERTIFICATE Important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A2. Building Street Address (including Apt., Unit, Suite, andlor Bidg. No.) or P.O. Route and Box No. 223 Bayside Drive City Clearwater State FL ZIP Code 33767 OMB No. 1660-0008 Expiration Date: July 31, 2015 A3. Property Description (Lot and Block Numbers, Tax Parcei Number, Legal Description, etc.j The Weserly 60 feet of Lot D, Biock 2, Bayside Subdivision No. 4, Unit A, Plat Book 36, Page 57 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Ftesidential _ .............. A5. Latitude/Longitude: lat. 27°58'10.52" Long. 82°49'22.31" Horizontal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7. Buiiding Diagram Number 6 AS. For a building with a crawispace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) ±2479 sq ft a) Square footage of attached garage ±2479 sq ft b) Number of permanent flood openings in the crawispace b) Number of permanent flood openings in the attached garage or enclosure{s) within 1.0 foot above adjacent grade 12 within 1.0 foot above adjacent grade n/a C) Total net area of flood openings in AS.b 2212 sq in c} Total net area of fiood openings in A9.b nia sq in d) Engineered flood openings? � Yes ❑ No d} Engineered flood openings? ❑ Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61. NFIP Community Name & Community Number 62. County Name 63. State City of Clearwater 125096 Pinelias FL 64. MapiPanel Number 65. Suffix 66. FIRM Index Date 67. FIRM Panel B8. Flood 69. Base Fiood Elevation(s) (Zone 12103C0102 G 9-3-03 Effective(Revised Date Zone{s) AO, use base flood depth) 9-3-03 AE 11' 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Itern 69. ❑ FIS Profile � FIRM ❑ Community Determined ❑ OthertSource: _______________ 611. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: _________ B12. Is the buiiding located in a Coastal Barrier Resources System {CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes � No Designation Date_ ____________ ❑ CBRS ❑ OPA SECTION C- BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* � Finished Constructian `A new Elevation Certificate wiil be required when construction of the building is complete. C2. Elevations - Zones A1-A30, AE, AH, A(with BFE), VE, V1-V30, V(with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. Complete Items C2.a-h below according to the buiiding diagram specified in Item A7. in Puerto Rico only, enter meters. Benchmark Utilized: City J 03,5" Vertical Datum NAVD'1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 � NAVD 1988 � Other/Source : ............ Datum used for building elevations must be the same as that used for the BFE. a} Top of bottom floor (including basement, crawlspace, or enclosure floor) b} Top of the next higher floor c} Bottom of the lowest horizontal structural member (V Zones only) d) Attached garage (top of slab) e) Lowest elevation of machinery or equipment servicing the building (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) g) Highest adjacent (finished) grade next to buiiding {HAG) h} Lowest adjacent grade at lowest elevation of deck or stairs, including structural support 5.66 16.28 n/a. 5.66 16.10 _...._ _...... 5..0 5.5 nla. Check the measurement used. � feet ❑ meters ❑ feet ❑ meters ❑ feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters � feet ❑ meters ❑ feet ❑ meters SECTION D- SURVEYOR, ENGINEER, OR ARCHITEGT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information on this Ceriificate represents my best efforts to rnterpret the data availabie. �*� �� I understand that any false statement may be punishable by fine or imprisonmeni under 18 U. S. Code, Section 1001. v�i �ir3i . � Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a �� , k� w��''��m . �� ❑ Check here if attachments. licensed land surveyor? � Yes ❑ No _ f.'��;x; xd"¢,��,_�, - MO RS]3 r... Certifier's Name Joseph E. Williamson, PlS Title Licensed F urveyor Address 941 ennsylvania Ave Signature FEMA For 086-0-33 (7/12} ........ . ____. __- _- _ License Number 6573 Company Name Vision Land Service City Winter Park State FL ZIP Code 32789 Telephone (888) 399-8474 See reverse side for continuation. • •fij,�RIYN. K �.+ , � � � �.,� �. ,' �'' n, •••.., ifl�a��C! . � ��ti'�k"�$�;�! +~� y . .e � ,yl t `'��^ . , Replaces ali previous editions. � �� - �-°�� _.. -- - yi .��...�.�I I� L� t �� _F � ;�c'��IN� & fJEUELOp _ _ _n �'I'rYt��'rR ��n,.�E�'�7z�EAT 223 BAYSIDE DR BCP2013-10410 NEW SFR BUNDY,NANCY Zoning: �ow �qedium Density Re Atlas #; 27Bq a;i.cr� ��viv �.nn � ia�i�.n � cr N°Kc c, IMPORTANT: In these spaces, copy the corresponding information from Section A. Bui6ding Stre;�t Address (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. FOR INSURANCE COMPANY USE � 223 Bayside Drive Policy NumbeE City Cieanvater State FL ZIP Code 33767 ° Company NAIC Number. SECTION D– SURVEYQR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) buiiding owner. Comments Item C2e w located on the Air Conditioner Pad Revised c ' icate - 3/13J15 Engineer ood openings for Item A8(d) are Smartvent Flood Vents Part No. �540-520 ,�t _.--� c�,. J ^ � � Date 2l23l15 i� ��. ��vn �– tsu��ulNG ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A(WITHOUT BFEj For Zones AO and A(without BFE), complete Items E1–E5. if the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B, and C. For Items E1–E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation information for the foliowing and check the appropriate boxes to shotv whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (lAG). a) Top of bottom floor (including basement, crawispace, or enclosure is , b) Top of bottom floor {including basement, crawlspace, or enclosure� is , � feet ❑ meters ❑ above or 0 below the HAG. ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent fiood openings provided in Section A Items 8 andlor 9(see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet E3. Attached garage (top of slab) is ❑ meters ❑ above or ❑ below the HAG. � ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of piatform of machinery and/or equipment servicing the building is . ❑ feet ❑ meters ❑ above or � below the HAG. E5. Zone AO only: if no flood depth number is available, is the top of the bottom ftoor elevated in accordance with the community's floodpiain 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(�vithout a FEMA-issued or community-issued BFE} or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my kno�vledge. Property Owner's or Owners Authorized Representative's Name Address Signature Comments City Date State ZIP Code Telephone L1 Check here if attachments SECTION G – COMMUNITY INFORMATION (OPTIONAL) The Iocal official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C(or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8–G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C �vas taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO. G3. ❑ The foilowing information (Items G4–G'10) is provided for community floodpiain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of CompliancelOccupancy �ssued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-buift lowest floor (including basement) of the building: �...___..___ ❑ feet ❑ meters Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's design flood elevation: — _.__._.__ .__ .__ ❑ feet ❑ meters Datum Local Official's Name Community Name Signature Comments FEMA Form 086-0-33 (7/12) Title Telephone Date - ❑ Check here if attachments. Replaces all previous edi!ions. ELEVATION CERTIFICATE, page 3 guilding Photographs , , See Instructions for item A6. IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 223 Bayside Drive City Clearwater State FL ZIP Code 33767 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number: If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page. � �� \ . �,��€� � � �Y � �, •� -r '�_' ` � � i ; . _ 'i �� _m ��..::�.-.�7—" �� t� � FEMA Form 086-0-33 (7/12) _,_j_ i � ____ „ �-� ._ ��_ � Front of House (2/20/15) �� r ,� � r ;;�� , ;. � � . � �. �� : ._ � �>, ' —�,¢,��- r �__ _..� ��'�rr" � � �3 � �n.�.�.. ��"�� •. �� n � � �, �� e � ',, � .sa.wnaa.» {R i� .5�� ' ��`�...� .. , >;-.;::. r� �. �� ■■ t ��1 � �� .�..�� . . . . .,. . , s ' ., , ., 0 Replaces all previous editions. I:LEVATION CERTIFICATE, page 4 guilding Photographs � � � Continuation Page IMF'ORTANT: In these spaces, copy the corresponding information from Section A. Buiiding Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 223 Bayside Drive City Clearwater State FL ZIP Code 33767 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number: If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. �� . �.. � ra.� . t �..,,,,, Rear of House (2/20/15l FEMA Form 086-0-33 (7/12) Replaces all previous editions. U.S. FJEPARTMENT OF HOMELAND 3ECURtTY FEDERA`L EMERG�NCY MANAGEMENT AGENCY ;\4�liunnl Flnod ,'nsm•tmre Progrcnn Owner's Name Nancy J. Bundy ELEVATION CERTIFICATE important: Read the instructions on pages 1-9. SECTION A - PROPERTY INFORMATION A2. Building StreetAddress (including Apt., Unit, Suite, and/or Bidg. No.) or P.O. Route and Box No. 223 Bayside Drive City Clearvvater State FL ZIP Code 33767 OMB No. 1660-0008 Expiration Date: July 31, 2015 FOR INSURANCE COMPANY USE Company NAIG Number: A3. Property Descripiion (Lot and Block Numbers, Tax Parcel Number, Legal Desc�ption, etc.) The Westerly 60 feet of Lot D, Block 2, Bayside Subdivison No. 4, Unit A, Plat Book 36, Page 57 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. 27°58'10.52" Long. 82°49'22.31" Horizonlal Datum: ❑ NAD 1927 � NAD 1983 A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance. A7, Building Diagram Number 7 A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage: a) Square footage of crawlspace or enclosure(s) t2179 sq ft a) Square footage of attached garage n!a sq ft b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage w enclosure(s} within 1.0 foot above adjacent grade 12 within 1.0 foot above adjacent grade Na c) Total net erea of flood openings in AB.b t1536 sq in c) Total net area of flood openings in A9.b Na sq in d) Engineered flood openings? ❑ Yes � No d) Engineered flood openings? ❑ Yes � No SECTION B- FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name &��ommunity Number 62. County Name B3. State City of Clearwater 125098 Pinellas Fl 64. Map/Panel Number B5. Suffx 86. FIRM (ndex Date B7. FIRM Panel B8. Flood B9. Base Flood Elevation(s) (Zone 12103C0102 G 9-3-03 EHective/Revised Date Zone(s) AO, use base flood depth) 9-3-03 AE 11' B10. Indicate the sourc� of the Base Flood Efevation (BFE) data or base flood depth entered in Item B9. ❑ FIS Profile � FIRM ❑ Community Determined ❑ Other/Source: 811. Indicate elevation detum used for BFE in Item B9: ❑ NGVD 1929 � NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Othervvise Protected Area (OPA)? ❑ Yes � No Designation Date: ❑ CBRS ❑ OPA SECTION C- BUILDING ELEVATION INFORMATION (SU RVEY RE(]UIREDj C1. Building elevations are based on: ❑ Construction Drawings" � Building Under Construction' ❑ Finished Construction � `A new Elevation Certificate will be required when construction of the building is complete. C2. Elevations - Zones A1 A30, AE, AH, A(with BFE), VE, V1-V30, V(with BFE}, AR, AR/A, AR/AE, ARJA1-A30, AR/AH, AR/AO. Complete Items C2.a-h ""� beiow according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. 1 Benchmark Utifized: Citv"J 03.5" Vertical Datum: NAVD1988 O Indicate elevation datum used for the elevations in items a) through h) below. � NGVD 1929 � NAVD 1988 � Other/Source: � Datum used for building elevations must be the same as that used for the BFE. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) �.C�6 b) Top of the next higher floor 16.10 c) Bottom of the lowest horizontal structural member (V Zones only) n/a._ d) Attached garage (top of slab) 5.66 e) Lowest elevation of machinery or equipment servicing the building n/a._ (Describe rype of equipment and location in Comments) Check the measurement used. � feet ❑ meters � � feet ❑ meters �./J p feet ❑ meters ..-. � feet ❑ meters Q ❑ feet ❑ meters � f) Lowest adjacent (finished) grade next to building (LAG) 5.0 � feet ❑ meters � g) Highest adjacent (finished) grade next to building (HAG) 5.5 � feet ❑ meters � h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support n/a._ ❑ feet ❑ meters /'1 !�� J -Z .� SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authoriz� by law to certify elevation �`t�t � i � rr�r� 1 undeastand that any /a/se statement may berpun sh/ able by �ne or imprsonmenf�underf 18 U.S.tCodeeSection �001. ��o`'gasWiV/t�� So� i�, ❑ Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a ��G� e�,A • i•'' ❑ Check here if attachments. licensed land surveyor? � Yes ❑ No �v No. 6573 :� : � _.--, -- . C Certifier s Name Joseph Williamson, PLS Title Licensed FLSurv Address 941 S Penn y a �� Signature FEMA Form 086- -33 (7/12) License Number 6573 Company Name �sion Land Service Park State FL ZIP Code 32789 Date 411114 Telephone (888) 399-8474 See reverse side for continuation. %r'A g STATE OF .�� : !��:�� FLORIDA •;�,� ��,�,�c,� • ��, /,,� E 111 I 1 t 1�,`` Replaces all previous editions. . a: L a� r A 1 1 V i\ a� ua� a a a� a�. r� i a: �{�a r„c i IMPORTANT: In these spaces, copy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. 223 Bayside Drive City Clearwater State FL ZIP Code 33767 FOR INSURANCE CQMPANY USE Policy Number. Company NAIC Number: SECTION D- SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED� Copy both sides of this Elevation Certificate for (1) community official, {2) insurance agenUcompany, and (3) building owner. Comments Signature �` Date 411114 SECTION E� BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR 20NE AO AND ZONE A(WITHOUT BFE) For Zones AO and A(without BFE), complete Items E1-E5. If the Certificate is intended to s�pport a LOMA or LOMR-F request, complete Sections A, B, and C. For Items E1-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, enter meters. E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure} is ❑ feet ❑ meters ❑ above or ❑ below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9(see pages 8-9 of Instructions), the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. E4. Top of platform af machinery andlor equipment servicing the building is ❑ feet ❑ meters ❑ above or � below the HAG. E5. Zone AO only: If no flood depth number is available, is the top of the bottom fbor elevated in accordance with the community's floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local o�cial must certify this information in Section G. SECTION F- PROPERTY OWNER (OR OWNER'S REPREBENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, a�d E for Zone A(without a FEMA-issued or commu�ity-issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Qwner's or Owner's Authorized Representative's Name Address Signature Comments City Date State Telephone ZIP Code Check here if attachments. SECTIaN G - COMMUNITY INFORMATION (OPTIOPIAL) The local official who is authorized by law or ordinance to administer the commun'rty's floodplain management ordinance can complete Sections A, B, C(or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G�-G10. In Puerto Rico only, enter meters. G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE) or Zone AO. G3. ❑ The folfowing information {Items G4--G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-built lowest floor (including basement) of the building: G9. BFE or (in Zone AO) depth of flooding at the building site: G1Q. Community's design flood elevation: Local Official's Name Community Name Signature Comments Title Telephone Date ❑ feet ❑ meters ❑ feet � meters Datum _ ❑ feet ❑ meters Datum _ Datum Check here if attachments. FEMA Form 086-0-33 (7/12) Replaces all previous editions. BL�VATIONCERTIFICATG,page3 guilding Photographs • See Instructions for Item A6. IMPORTANT: In these spaces, capy the corresponding information from Section A. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Z23 Bayside Drive City Gearwater State FL ZIP Code 33767 FOR INSURANCE COMPANY USE Policy Number: Company NAIC Number: If using the Elevation Certificate to obtain NFIP flood insurance, a�x at least 2 building photog�aphs belaw according to the instructions far Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Section A8. If subrnitting more photographs than will fit on this page, use the Continuation Page. 5' � �� .� �� ` k-° Front of House (3/31/14) �"'---�—""'".r- ..,,..-�—..' ..---^' m �� E� � 4 Yd'�'::x`^ "t .tV�',.�a � _ �`a'�++�,..�� ag �r;, .._.. . ��. ....e ��.. . � �� -. � . .�..� .. � .. � �� i� ^r+` '` fid€��h" ._ g� r,�r'� «�».�.., � � , a'� ;`� � ... t�, p : I ° � �,� ; � � �� ; .;,�� , = i �. i � � � � � � �`�'� � � .; � i � ��I I 11 �; �� FEMA Form Q86-0-33 (7l12) Replaces all previous editions. � . ELr�ATIO�T CERTIFtCATE, page4 guilding Photographs ' Continuation Page IMPORTANT: in these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Building Street Address (inciuding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Policy Number. 223 Bayside Drive City Clearwater State FL ZIP Code 33767 Company NAIC Number. if submitting more photographs than wiii fit on the preceding page, affix the additional photographs below. Identify all photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as indicated in Sec6on A8. Rear of Hause (3/31/14) � � �,, � � � � � � _ �, . �,�,r..� � � . �: �� ;�� V �,.��° � � � � �� r ` � . � `�` ,..�'""'.. ,,�. a .ti � . .. � , � �'` ' � � `° ��,� � °^�,w.�""„� �,.�-� � daA °w � ., , . �' � �.� ., " _ ~"`" �' "'��.' ��,,. ..a- �� .., ' 4 �' ,� ��"�w ,�� ........, � �, , , , � . °*,�, � ,.�� , � .� �� ,�r,� �:"�.�..�..,,� „�� «� , ,� , ; I' � � �. x, r _ , 4 ......�+e.evW+y� . .. � � � -. Y~ "' �, � '� V � � ' � �° � .. �, � `�' � ,� , � ;: �. t� ,.. _.., � � , � �K� � ti �� '�,, �_�� 4 8 � ,, � � *. . �� " � ��.. �� ;, �� . �.Mn � .. ,� m .._ ... .... ,�Y4 .�:. d .� + � ' � = .:,.� ,. � �. � �``��~�� .� . � �� w � w.. � $ �¢�q��y� r��h . . , „,. , �� t �,.� � �r.,�x„n�a^,�„,a� ., ,.:.< � � � ��, � �' � . . � � � .. ry ��..,, �� a �� .�� , � � �� ,} � - . �. � , � �._ . � ' � �� - ��.�� kv 1 '� . . A ` q � '�'f� .. . .. . "^�i.�" � . FEMA Form 086-0-33 (7112) Replaces all previous editions.