613 ISLAND WAYU.S. DEPARTMENT OF HOMELAND SECURITY
Federal Emergency Management Agency
National Flood Insurance Program
ELEVATION CERTIFICATE
Important Follow the instructions on pages 1-9.
OMB No. 1660-0008
Expiration Date: November 30, 2018'
all pages of this Elevation Certificate and all attachments for (1) community official. (2) Insurance agent/company, and (3) building owner.
SECTION A — PROPERTY INFORMATION
FOR INSURANCE COMPANY USE
Al. Building Owner's Name
GLEN EDWARD MICHEL 17 -76690
Policy Number:
A2 Building' Street Address (Wilding Apt, Unit, Suite, and/Or Bldg. No.) or P.O. Route and
Box No.
613 ISLAND WAY
Company NAIC Number:
City State ZIP Code
CLEARWATER Florida 33767
A3. Property Description (Lot and Block Numbers. Tax Parcel Number, Legal Description, etc.)
PARCEL ID- 05-29-15-43458-000-0010 NOT FOR CONSTRUCTION, NOT FOR DESIGN
M. Building Use (e.g..
A5. Latilude&Longtlude:
A8. Attach at least
A7. Building Diagram
A8. For a building with
a) Square footage
b) Number of permanent
c) Total net area
d) Engineered
A9. For a building with
a) Square footage
b) Number of permanent
c) Total net area
d) Engineered
Residential, Non- Residential. Addltlon.
Lat.2r59'10.5" Long. - 8249'07.?
Accessory. etc.) RESIDENTIAL
Horizontal Datum:
obtain flood insurance.
1.0 foot above adjacent
above adjacent grade
0 NAD 1927
grade
igi NAD 1983
WA
2 photographs of the bulkfing lithe
Number 1A
Certificate is being used to
N/A sq It
a crawlspace
of crawlspaca
flood
of flood openings
flood
an attached
of attadied
flood
of flood openings
flood openings?
or endosure(s):
or enclosure(*)
openings in the crawispace
in AB.b 0 sq
or enclosure(s) within
in
sq ft
within 1.0 foot
sq in
WA
? Oyes K No
garage:
garage 550
openings in the attached garage
in A9b WA
■ Yes i'.t No
SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NAP Community Name & Community Number
CITY OF CLEARWATER - 125096
82. County Name
PINELLAS
83. State
Florida
84.
Number
12103C-0102
85. Sulibc
G
86. FIRM
09/03/2003
B7. FIRM
Revised Date
090312003
Be. Flood Zone(s)
AE
89. Base Flood Elevation(s)
FloArodd Depth)
12'
B10. Indicate the source
❑ lS Profile
BI 1. Indicate elevation
812. Is the building
Designaticn Date:
of the Base Flood Elevation (BFE)
21 FIRM ❑ Community Delendned
datum used for BFE in Item 89:
boated in s Coastal Ranier Resources
❑ CBRS
data or base flood depth
entered in Item B9:
■ Other/Soirce:
1929 ® NAVD 1988 0 Other/Source:
(CBRS) area or Otherwise Protected
❑ OPA
■ NGVD
System
Area (OPA
es No
FEMA Form 066 -0-33 (7/15)
Replaces all previous
Form Page 1 of 7