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2600 MCCORMICK DRU.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: November 30, 2018 Important: Follow the instructions on pages 1-9. 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 Skye Lane Properties, LLC Policy Number: A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 2600 McCormick Dr. Company NAIC Number City State ZIP Code Clearwater Florida 33759 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Prestige Place Sub Tract 1 PID# 32-28-16-73099-000-0010 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 c) Total net area d) Engineered A9. For a building a) Square footage b) Number of c) Total net area d) Engineered Residential, Non -Residential, Addition, Accessory, etc.) Lat. 27°59'58.34 N Long. 82°43'42.03" W Non -Residential Horizontal Datum: obtain flood insurance. 1.0 foot above adjacent above adjacent grade ❑ NAD 1927 grade x NAD 1983 0 2 photographs Number with a crawlspace of crawlspace permanent flood of flood openings flood openings? with an attached of attached permanent flood of flood openings flood openings? of the building if the 1A Certificate is being used to sq ft or enclosure(s): or enclosure(s) openings in the crawlspace in A8.b sq or enclosure(s) within in sq ft within 1.0 foot sq in ❑ Yes ❑ No garage: garage openings in the attached garage in A9.b ❑ Yes ❑ No SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION - B4. NAPC-ommunity Name & Ebmmunity Number Pinellas County Unincorporated 125139 B2. County Name Pinellas B3. State Florida B4. Map/Panel Number 12103C 0126 B5. Suffix G B6. FIRM Index Date 08/18/2009 B7. FIRM Panel Effective/ Revised Date 09/03/2003 B8. Flood Zone(s) X B9. Base Flood Elevation(s) (Zone AO, use Base Flood Depth) B10. Indicate the source ❑ FIS Profile B11. Indicate elevation B12. Is the building Designation Date: of the Base Flood Elevation (BFE) ❑ Community Determined for BFE in Item B9: Coastal Barrier Resources ❑ CBRS data ❑ ❑ NGVD System or base flood depth entered in Item B9: Other/Source: x FIRM datum used located in a 1988 ❑ Other/Source: or Otherwise Protected 1929 x NAVD (CBRS) area ❑ OPA Area (OPA)? ❑ Yes ❑ No Replaces all previous editions. Form Page 1 of 6 2600 MCCORMICK DR BCP2017-05647 GENERATOR SKYE LANE PROPERTIES LLC Atlas #: 244A Zoning: Office ELEVATION CERTIFICATE OMB No. 1660-0008 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. 2600 McCormick Dr. Policy Number: City State ZIP Code Clearwater Florida 33759 Company NAIC Number SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under 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, Complete Items C2.a—h below according to the building diagram specified in Item A7. In Puerto Rico only, Benchmark Utilized: City of Clearwater BM J-14 Vertical Datum: NAVD 1988 x Finished Construction AR/AH, AR/AO. enter meters. Indicate elevation datum ❑ NGVD 1929 used 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) 88. 82 x the measurement used. feet ❑ meters b) Top of the next higher floor 100 27 x feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) x feet ❑ meters d) Attached garage (top of slab) x feet ❑ meters e) Lowest elevation of machinery or equipment servicing the building 89 62 x feet ❑ meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to building (LAG) 87. 9 x feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 88. 6 x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, includingx feet ❑ meters structural support SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect I certify that the information on this Certificate represents my best efforts to interpret statement may be punishable by fine or imprisonment under 18 U.S. Code, Section Were latitude and longitude in Section A provided by a licensed land surveyor? x authorized by law to certify elevation information. the data available. I understand that any false 1001. Yes ❑ No ❑ Check here if attachments. Certifier's Name License Number Dennis J Eyre 2865 Place Seal Here Title Land Surveyor Company Name Geodata Services, Inc. Address 1166 Kapp Drive City State ZIP Code Clearwater Florida 33765 Signatu \ 00: Date Telephone 12( • 06/06/2017 (727) 447-1763 Copy all pages of this Elevati• Certific.- an• all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. Comments (including ty•' of equip ent and location, per C2(e), if applicable) C2 e) Lowest machine servicing the building is the outdoor electrical outlet 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. 2600 McCormick Dr. Policy Number: City State ZIP Code Clearwater Florida 33759 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, B,and 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: 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. 2600 McCormick Dr. Policy Number: City State ZIP Code Clearwater Florida 33759 Company NAIC Number SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordinance Sections A, B, C (or E), and G of this Elevation used in Items G8—G10. In Puerto Rico only, enter G1. ❑ The information in Section C was taken engineer, or architect who is authorized data in the Comments area below.) G2 ❑ A community official completed Section or Zone AO. to administer the community's floodplain management ordinance can complete Certificate. Complete the applicable item(s) and sign below. Check the measurement meters. from other documentation that has been signed and sealed by a licensed surveyor, by law to certify elevation information. (Indicate the source and date of the elevation E for a building located in Zone A (without a FEMA -issued or community -issued BFE) is provided for community floodplain management purposes. 03. • The following information (Items G4—G10) 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 B J1LO NO PHOTO-GARH S 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., ,yrift, Suite, and/or Bldg. No.) or P.O. Route ndl Box_o. 2600 McCormick Dr. Policy ,Number: City State ZIP Code Clearwater Florida 33759 Company NAIC Number tt using the Elevation Certificate to obtain r4F[,P 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 Mage. u 'f+•k *moi "'S .-_ "+t*.r Photo One Photo One Caption tt • { .. {,{ r 'fie-.. •� — r J r L • < '" � s Photo Two Photo Two Caption 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. lip.) or P.O. Route and Box No. 2600 McCormick Dr. Policy Number: City State ZIP Code Clearwater Florida 33759 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. .' a= • •7:. _ . Photo One Photo One Caption 3� a�.ti` 2Il ,.. .. Photo Two Photo Two Caption FEMA Form 086-0-33 (7/15) Replaces all previous editions. Form Page 6 of 6 i U.S. DEPARTMENT OF HOMELAND SECURITY Federal Emergency Management Agency National Flood Insurance Program ELEVATION CERTIFICATE Important: Foliow 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 agenUcompany, and (3) building owner. SECTION A— PROPERTY INFORMATION FOR INSURANCE COMPANY USE A1. Building Owner's Name Policy Number: Skye Lane Properties, LLC A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Company NAIC Number: Box No. 2600 McCormick Dr. City State ZIP Code Clearwater Florida 33759 A3. Property Description (Lot and Block Numbers, Tax Parcel Number, �egal Description, etc.) Prestige Place Sub Tract 1 PID# 32-28-16-73099-000-0010 A4. Building Use (e.g., Residential, Non-Residential, Addition, Accessory, etc.) Non-Residential A5. Latitude/Longitude: Lat. 27°59'58.34 N Long. 82°43'42.03" W Horizontal Datum: � NAD 1927 Q 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 1A A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawispace or enclosure(s) sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A8.b sq in d) Engineered flood openings? ❑ Yes ❑ No A9. For a building with an attached garage: a) Square footage of attached garage sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade c) Total net area of flood openings in A9.b sq in d) Engineered Flood openings? � Yes � No SECTION B— FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 81. NFIP Eommunity Name & Community Number B2. Gounry Name B3. Sfate Pinellas Counry Unincorporated 125139 Pinellas Florida B4. Map/Panel B5. Suffix B6. FIRM Index 67. FIRM Panel 68. Flood Zone(s) B9. Base Flood Elevation(s) Number Date Effective/ (Zone AO, use Base Revised Date Flood Depth) 12103C 0126 G 08/18/2009 09/03/2003 X 610. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 69: ❑ FIS Profile �x FIRM � Community Determined � Other/Source: B11. Indicate elevation datum used for BFE in Item 69: ❑ NGVD 1929 x0 NAVD 1988 � Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? � Yes � No Designation Date: � CBRS � OPA FEMA Form 086-0-33 (7/15) Replaces ali previous edi � O 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 Bidg. No.) or P.O. Route and Box No. Policy Number: 2600 McCormick Dr. City State ZIP Code Company NAIC Number Clearwater Florida 33759 SECTION C— BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. 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 compiete. 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: City of Clearwater BM J-14 Vertical Datum: NAVD 1988 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ❑x NAVD 1988 ❑ Other/Source: Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom floor (including basement, crawlspace, or enclosure floor) 88 SZ Ox feet � meters b) Top of the next higher floor 100 27 � feet � meters c) Bottom of the lowest horizontal structural member (V Zones oniy) . x0 feet ❑ meters d) Attached garage (top of slab) . �x feet � meters e) Lowest elevation of machinery or equipment servicing the building 89 62 �x feet � meters (Describe type of equipment and location in Comments) � Lowest adjacent (finished) grade next to building (LAG) $� 9 Ox feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 88 6 []x feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, inciuding � feet � meters structural support 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. l 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 Dennis J Eyre 2865 Title Land Surveyor Company Name Place Geodata Senrices, Inc. Seal Address Here 1166 Kapp Drive City State ZIP Code Clearwater Florida 33765 Signatu � Date Telephone 06/06/2017 (727) 447-1763 Copy all pages of this Elevati Certiflc an all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner. Comments (including ty of equip ent and location, per C2(e), if applicable) C2 e) Lowest machine servicing the building is the outdoor electrical outlet � ����� rVllll VOV-V-JJ �// 10) rtepiaces all previous editions. Form Page 2 of 6 OMB No. 1660-0008 ELEVATION CERTIFICATE Expiration Date: November30, 20�8 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: 2600 McCormick Dr. City State ZIP Code Company NAIC Number Clearwater Florida 33759 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 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 foilowing 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, crawispace, 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 andlor 9(see pages 1-2 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 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 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. 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. rciwrr rorm vub-u-.s.s 1���5) Replaces aii previous editions. Form Page 3 of 6 ELEVATION CERTIFICATE OMB No 1660-0008 Fxniratinn Ilata� Nnuamhar �h 7l11A 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: 2600 McCormick Dr. City State ZIP Code Company NAIC Number Clearwater Florida 33759 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 buiiding 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: � New Construction � Substantial Improvement G8. Elevation of as-built 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 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 BiiIL�iNG PHO�(OG�F�i�S OMB No. 1660-0008 ELEVATION CERTIFICATE See Instructions for Item A6. Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Bu.itc�ing Stree� Ac�dress (inciuding Apt., �1nit, Suite, andlor B1dg. No.j or P.O. Route and Sox No. Palicy Number: 2600 McCormick Dr. ��t'Y Stafe ;ZIP Code Company NAIC Number Clearwater Florida 33759 1f using tf�e ESevati�� Cer¢i�ica�e �o obtain I��I�� ff�od insurance, affix at �east Z bui(tfing pf�qtographs bef�w accorc�r�g �o t�e 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 irtidicafed i� Sectum �fi8. Lf s�lamittix�g ce�ar� phatagraPhs tha� �rill. fit ar� this page, u�e th� �crr�tu►�aatiat� P�age. Phoro One Photo One Caption PhotO ?wo Photo Two Caption FEMA Form 086-0-33 (7l15) Repiaces all previous editions. Form Page 5 of 6 ����'����' ���������5 OMB No. 1660-0008 ELEVATION CERTIFICATE Continuation Page Expiration Date: November 30, 2018 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Bui�c�fr�g Stfeet Adct�ess ��n�kud��rg Apt_, �n��, Suifie, arrd!tar Bfdg. ►�o.T ar P.Q. Rocrte and Box f+Fa. Pcr�tcy Pktrrrkrer. 2600 McCormick Dr. ���f 5'tate ZIP �ode. Gompany N,�IC Number Clearwater Florida 33759 If submitt+ng more photograpt�s than wi�� ftt on th� preceding page, a�fix the adrl+tional photographs below. Identify a�l photographs with: date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." 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Form Page 6 of 6