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1516 FLOURNOY WAYU.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICA' Important: Follow the instructions on pages 1—c. Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) ins SECTION A — PROPERTY INFORMATION Al. Building Owner's Name FDC CLEARWATER PSE, LLC Y^' RECEIVED BY: JAN 1 2019 PLANNING & DEVELOPMENT CITY OF CLEARWATER 1516 FLOURNOY VVHY A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route an BCP2016-07639H 1516 FLOURNOY WAY ELEVATION CERTIFICATE 0F'! L' VUE AT BELLAIR , / Box No. City CLEARWATER State Florida Zoning: Commercial Atlas #: 318A A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) VUE AT BELLEAIR BUILDING 8 A4. Building Use (e.g., A5. Latitude/Longitude: A6. Attach at least A7. Building Diagram A8. For a building 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, Addition, Accessory, etc.) Lat. 27°56'28.16"N Long. 82°43'40.34'W RESIDENTIAL Horizontal Datum: ❑ NAD 1927 insurance. above adjacent grade grade N/A X NAD 1983 N/A 2 photographs Number with a crawlspace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? of the building if the 1A Certificate is being used to obtain flood N/A sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) N/A sq in within 1.0 foot foot above adjacent in N/A sq ft ❑ Yes X No garage: garage openings in the attached garage within 1.0 in A9.b N/A sq ❑ Yes X No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION Bl. NFIP Community Name & Community Number CITY OF CLEARWATER 125096 B2. County Name PINELLAS B3. State Florida B4. Map/Panel Number 12103C0128 B5. Suffix G B6. FIRM Index Date 09-18-2009 B7. FIRM Panel Effective/ Revised Date 09-03-2003 B8. Flood Zone(s) AE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 9 B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data or base flood ❑ Other/Source: ❑ NGVD 1929 System (CBRS) CBRS ❑ OPA depth entered in Item B9: X FIRM datum used located in a Date: ❑ Other/Source: X NAVD 1988 area or Otherwise Protected Area (OPA)? ❑ Yes X No FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 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. 1516 FLOURNOY WAY Policy Number: City State ZIP Code CLEARWATER Florida 33764 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations *A new Elevation C2. Elevations — Zones Complete Items Benchmark Utilized: Indicate elevation ❑ NGVD Datum used for building a) Top of bottom b) Top of the next c) Bottom of the d) Attached garage e) Lowest elevation (Describe type f) Lowest adjacent g) Highest adjacent h) Lowest adjacent structural support are based on: ❑ Construction Drawings* ❑ Building Under Construction* Certificate will be required when construction of the building is complete. Al A30, AE, AH, A (with BFE), VE, V1 V30, V (with BFE), AR, AR/A, AR/AE, C2.a—h below according to the building diagram specified in Item A7. In Puerto B-14 CLEARWATER Vertical Datum: 1988 x Finished Construction AR/A1 A30, AR/AH, AR/AO. Rico only, enter meters. datum used for the elevations in items a) through h) below. 1929 0 NAVD 1988 ❑ Other/Source: elevations must be the same as that used for the BFE. floor (including basement, crawlspace, or enclosure floor) 10.50 Check the measurement used. a feet ❑ meters higher floor 21.40 a feet ❑ meters lowest horizontal structural member (V Zones only) N/A ❑ feet ❑ meters (top of slab) 10.15 X feet ❑ meters of machinery or equipment servicing the building 10.32 of equipment and location in Comments) a feet meters (finished) grade next to building (LAG) 9.40 X feet ❑ meters (finished) grade next to building (HAG) 10.30 a feet ❑ meters grade at lowest elevation of deck or stairs, including feet meters N/A ❑ ❑ SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to I certify that the information statement maybe punishable Were latitude and longitude be signed and sealed by a land surveyor, engineer, or architect authorized by on this Certificate represents my best efforts to interpret the data available. by fine or imprisonment under 18 U.S. Code, Section 1001. law to certify elevation information. I understand that any false ❑ Check here if attachments. in Section A provided by a licensed land surveyor? M Yes ❑ No Certifier's Name License Number DAN H. RIZZUTO 5227 . a r ', r t ` , . n ' <h N _ Qy / o� .m ;;:, , 't,, ,((7- 4+1Qa°aQ .: Title LAND SURVEYOR°'°' Company Name POLARIS ASSOCIATES, INC. Address 2165 SUNNYDALE BOULEVARD City CLEAR AT R State ZIP Code Florida 33765 Signatu \ Date Telephone Ext. 11-29-2018 (727)461-6113 Copy all ag of this'El. 'n Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including type of equipment and location, per C2(e), if applicable) 1. SURVEY MAP AND REPORT OR THE COPIES THEREOF ARE NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. ADDITIONS OR DELETIONS TO SURVEY MAPS OR REPORTS BY OTHER THAN THE SIGNING PARTY OR PARTIES IS PROHIBITED. 2. POLARIS JOB #4552 FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 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. 1516 FLOURNOY WAY Policy Number: City State ZIP Code CLEARWATER Florida 33764 Company NAIC Number SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1—E5. If the Certificate is intended to support a complete Sections A, Band C. For Items E1—E4, use natural grade, if available. Check the measurement enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters LOMA or LOMR-F request, used. In Puerto Rico only, the elevation is above or below ❑ above or ❑ below the HAG. ❑ above or ❑ below the LAG. 9 (see pages 1-2 of Instructions), b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters ■ above or ❑ below the HAG. ❑ above or ❑ below the HAG. ❑ above or ❑ below the HAG. with the community's certify this information in Section G. E3. Attached garage (top of slab) is ❑ feet ❑ meters E4. Top of platform of machinery and/or equipment servicing the building is ❑ feet ❑ meters E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must 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. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 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. 1516 FLOURNOY WAY Policy Number: City State ZIP Code CLEARWATER Florida 33764 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local 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 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 following 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: ❑ G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: New Construction ❑ Substantial Improvement basement) ❑ feet ❑ feet ❑ feet ❑ meters Datum building site: ❑ meters Datum ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS See Instructions for Item A6. OMB No. 1660-0008 Expiration Date: November 30, 2018 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. 1516 FLOURNOY WAY Policy Number: City State ZIP Code CLEARWATER Florida 33764 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. I� r �� "��rwK .m..., v r �TJY ....r, TTllffliMMO Nig Photo One Photo One Caption FRONT VIEW (EAST) Clear Photo One ti 14-4404 204 8e- (' Photo Two Photo Two Caption RIGHT SIDE (NORTH) Clear Photo Two FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS Continuation Page OMB No. 1660-0008 Expiration Date: November 30, 2018 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. 1516 FLOURNOY WAY Policy Number: City State ZIP Code CLEARWATER Florida 33764 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. II I � *mob Photo �s2.a« y r Three Photo Three Caption REAR VIEW (WEST) Clear Photo Three II iii Tela `N0 E3 1!4.:1.6 - Photo Four Photo Four Caption LEFT SIDE (SOUTH) Clear Photo Four FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 U.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 Copy 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 FDC CLEARWATER PSE, LLC Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and /or Bldg. No.) or P.O. Route and 1516 FLOURNOY WAY Company NAIC Number: City State ZIP Code CLEARWATER Florida 33764 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) VUE AT BELLEAIR BUILDING 8 A4. Building Use (e.g., A5. Latitude /Longitude: A6. Attach at least A7. Building Diagram A8. For a building 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, Addition, Accessory, Lat. 27 °56'28.16 "N Long. 82 °43'40.34'W etc.) RESIDENTIAL Horizontal Datum: insurance. above ❑ NAD 1927 adjacent grade grade N/A a NAD 1983 0 2 photographs Number with a crawlspace of crawlspace flood of flood openings flood openings? an attached of attached flood of flood openings flood openings? of the building if the 1A Certificate is being used to obtain flood 1902.00 sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b or enclosure(s) 0.00 sq in within 1.0 foot foot above adjacent in N/A sq ft ❑ Yes 11 No garage: garage openings in the attached garage within 1.0 in A9.b N/A sq ❑ Yes a No SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP Community Name & Community Number CITY OF CLEARWATER 125096 B2. County Name PINELLAS B3. State Florida B4. Map /Panel Number 12103C0128 B5. Suffix G B6. FIRM Index Date 09 -18 -2009 B7. FIRM Panel Effective/ Revised Date 09 -03 -2003 B8. Flood Zone(s) AE B9. Base Flood E evation(s) (Zone AO, use Base Flood Depth) 9 B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ (BFE) data ❑ NGVD System CBRS or base flood ❑ Other /Source: depth entered in Item B9: a FIRM datum used located in a ❑ Other Protected /Source: 1929 a NAVD 1988 (CBRS) area or Otherwise ❑ OPA Area (OPA)? ❑ Yes V1 No FEMA Form 086 -0-33 (7/15) Replaces all previous editions. Form Page 1 of 6 "REVISED" PLANS RECEIVED BY: I.M JAN 3 1 2019 PLANNING & Lai- vELOPMENT CITY CF CLEARWATER ELEVATION CERTIFICATE OMB No. 1660 -0008 Expiration Date: Nov 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. 1516 FLOURNOY WAY Policy Number: City State ZIP Code CLEARWATER Florida 33764 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* x 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, AR/A1—A30, AR /AH, AR/AO. Complete Items C2.a —h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters. Benchmark Utilized: B -14 CLEARWATER Vertical Datum: 1988 Indicate elevation datum used ❑ NGVD 1929 X for the elevations in items a) through h) below. NAVD 1988 ❑ Other /Source: Datum used for building elevations must be the same as that used for the BFE. Check a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 10.15 a the measurement used. feet ❑ meters feet ❑ meters b) Top of the next higher floor 10.50 ❑ ❑ X X X c) Bottom of the lowest horizontal structural member (V Zones only) N/A feet In meters d) Attached garage (top of slab) N/A feet ❑ meters feet meters ❑ feet ❑ meters feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 10.32 (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 9.40 g) Highest adjacent (finished) grade next to building (HAG) 10.30 h) Lowest adjacent grade at lowest elevation of deck or stairs, including structural support N/A ❑ feet ❑ meters SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT 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 Certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? X Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number DAN H. RIZZUTO 5227 q g � t � � I a0 e �, ` ,� i.3•• ' !ti,�.tu °� _ y ,�.v� w y, • „ s- --- - / 0 ," h. � • , �'" . �•, �n pj ,-f. _ ±- r .. ,4 ` e k \ { q Title LAND SURVEYOR Company Name POLARIS ASSOCIATES, INC. Address 2165 SUNNYDALE BOULEVARD City CLEARW State ZIP Code / Florida 33765 Ali Signature Date Telephone Ext. �� '� 11 -29 2018 (727) 461 -6113 Copy all pag -s of this lev: Ii ertificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including typ. • equipment and location, per C2(e), if applicable) 1. SURVEY MAP AND REPORT OR THE COPIES THEREOF ARE NOT VALID WITHOUT THE SIGNATURE AND THE ORIGINAL RAISED SEAL OF A FLORIDA LICENSED SURVEYOR AND MAPPER. ADDITIONS OR DELETIONS TO SURVEY MAPS OR REPORTS BY OTHER THAN THE SIGNING PARTY OR PARTIES IS PROHIBITED. 2. POLARIS JOB #4552 FEMA Form 086 -0-33 (7/15) Replaces all previous editions. Form Page 2 of 6 ELEVATION CERTIFICATE OMB No. 1660 -0008 Expiration Date: November 30, 2018 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. 1516 FLOURNOY WAY Policy Number: City State ZIP Code CLEARWATER Florida 33764 Company NAIC Number SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zones AO and A (without BFE), complete Items E1 —E5. If the Certificate is intended to support a complete Sections A, Band C. For Items E1 —E4, use natural grade, if available. Check the measurement enter meters. El. Provide elevation information for the following and check the appropriate boxes to show whether the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters LOMA or LOMR -F request, used. In Puerto Rico only, the elevation is above or below ❑ above or ❑below the HAG. above or ❑ ❑below the LAG. 9 (see pages 1 -2 of Instructions), ❑ above or ❑ below the HAG. ❑above or below the HAG. ❑ above or ❑ below the HAG. with the community's certify this information in Section G. b) Top of bottom floor (including basement, crawlspace, or enclosure) is ❑ feet ❑ meters E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and /or the next higher floor (elevation C2.b in the diagrams) of the building is ❑ feet ❑ meters E3. Attached garage (top of slab) is feet ❑ meters E4. Top of platform of machinery and /or equipment servicing the building is ❑ feet ❑ meters E5. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated in accordance floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must 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. The statements in Sections A, B, and E are correct to the best of my knowledge. Property Owner or Owner's Authorized Representative's Name Address City State ZIP Code Signature Date Telephone Comments • Check here if attachments. FEMA Form 086 -0-33 (7/15) Replaces all previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No. 1660 -0008 Expiration Date: 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. 1516 FLOURNOY WAY Policy Number: City State ZIP Code CLEARWATER Florida 33764 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local 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 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 following 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: ❑ G8. Elevation of as -built lowest floor (including of the building: G9. BFE or (in Zone AO) depth of flooding at the G10. Community's design flood elevation: New Construction ❑ Substantial Improvement basement) ❑ feet ❑ feet ❑ feet ❑ meters Datum building site: ❑ meters Datum ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. A Form 086 -0-33 (7/15) Replaces all previous editions. Form Page 4 of 6 Clear Photo Two BUILDING PHOTOGRAPHS ELEVATION CERTIFICATE See Instructions for Item A6. OMB No. 1660 -0008 Expiration Date: November 30, 2018 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. 1516 FLOURNOY WAY Policy Number: City State ZIP Code CLEARWATER Florida 33764 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. Photo One Photo One Caption FRONT VIEW (EAST) Photo Two Photo Two Caption RIGHT SIDE (NORTH) FEMA Form 086 -0 -33 (7/15) Clear Photo One Replaces all previous editions. Form Page 5 of 6 ELEVATION CERTIFICATE BUILDING PHOTOGRAPHS OMB No. 1660 -0008 Continuation Page Expiration Date: November 30, 2018 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. 1516 FLOURNOY WAY Policy Number: City CLEARWATER State ZIP Code Florida 33764 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. Photo Three Photo Three Caption REAR VIEW (WEST) Clear Photo Three Photo Four Photo Four Caption LEFT SIDE (SOUTH) Clear Photo Four FEMA Form 086 -0 -33 (7/15) Replaces all previous editions. Form Page 6 of 6