City of Jefferson, Missouri

City of Jefferson, Missouri PRE-CONSTRUCTION ELEVATION CERTIFICATION FORM

This form must be completed by a registered professional engineer, architect or professional land surveyor.

I CERTIFY that the structure proposed for the property location described below was designed so that the lowest finished floor is at an elevation of ______feet NGVD (mean sea level).

If there will be a floor beneath the lowest finished floor, please describe and give elevation of same.

LOCATION OF PROPERTY:

Date Signature

Name (typed or printed)

Address

City, State, and Zip

(Affix)

CITY OF JEFFERSON John G. Christy Municipal Building 320 East McCarty Street, Jefferson City, MO. 65101 Phone: (573) 634-6410 / Fax: (573) 634-6562

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