<p> City of Jefferson, Missouri PRE-CONSTRUCTION ELEVATION CERTIFICATION FORM</p><p>This form must be completed by a registered professional engineer, architect or professional land surveyor.</p><p>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).</p><p>If there will be a floor beneath the lowest finished floor, please describe and give elevation of same.</p><p>LOCATION OF PROPERTY:</p><p>Date Signature</p><p>Name (typed or printed)</p><p>Address</p><p>City, State, and Zip</p><p>(Affix)</p><p>CITY OF JEFFERSON John G. Christy Municipal Building 320 East McCarty Street, Jefferson City, MO. 65101 Phone: (573) 634-6410 / Fax: (573) 634-6562</p><p>MARCH 2013 PAGE 1 OF 1</p>