Project Address:
Owner Address:
I am completing FEMA Affidavits:
I do not have an elevation certificate
Not enough adequate flood venting or machinery is not at the required elevation
The finished floor elevation is below the required elevation
As the owner of this property I understand that by choosing either a private FEMA appraisal or by using Collier County
Property Appraiser to obtain the market value of the structure I will be obligated to use this form of market value for the
next five (5) years from CO of this project.
Market Value obtained by:
Private Appraisal
Collier County Property Appraisers
1. Assessed value (less accessory structures)
2. 20% adjusted value (skip if private appraisal)
3. Total Market Value
4. 49.9% of market value
5. Value of this work from Contractors Affidavit
6. Cumulative of FEMA work over last 5 years
- $
7. Remaining FEMA balance over next 5 years
I hereby attest to the fact I understand and acknowledge the information regarding the FEMA construction allowed at
my property under this permit. Understand and acknowledge the Contractor’s Affidavit value of improvement and the
Owner Affidavit remaining balance for the cumulative of 5 years.
Print Name of Owner
Signature of Owner
Owner Affidavit FEMA Balance Verification
click to sign
click to edit