Laserfiche WebLink
ELEVATION CERTIFICATE <br />OMS No. 1660-0008 <br />Expiration Date: November 30, 2022 <br />IMPORTANT: In these spaces, copy the cormsponding information from Section A. <br />FOR INSURANCE COMPANY USE <br />Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No, <br />Policy Number: <br />480 CEDAR COVE RD. <br />City State ZIP Code <br />Company NAIC Number <br />ELLENSBURG Washington 98926 <br />SECTION G — COMMUNITY INFORMATION (OPTIONAL) <br />The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete <br />Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement <br />used in Items G8--1310. In Puerto Rico only, enter meters. <br />G1. ❑ The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, <br />engineer, or architect who is authorized by law to certify elevation information. (Indicate the source and date of the elevation <br />data in the Comments area below_) <br />G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community -issued BFE) <br />or Zone AO. <br />133. F-1 The following information (Items G4 --G10) is provided for community floodplain management purposes. <br />G4. Permit Number G5. fate Permit Issued <br />G6. Date Certlficete of <br />i= D - 6 -- ���� 3 <br />Compliance/Occupency Issued <br />;Q �� - z <br />137. This permit has been issued for. I New Construction ❑ Substantial Improvement <br />G8. Elevation of as -built lowest floor (including basement) <br />of the building: _JCia6 -1 ['feet ❑ meters Datum wg,ty , d`j <br />G9. BFE or (in Zone AO) depth of flooding at the building site: 1500 Q 19feet ❑ meters Datum 1.i [ us3 .2 q <br />G10. Communitys design flood elevation: (MELDo gt [Rfeet D meters Datum -Zel <br />Local official's Name Titre <br />Community Name Telephone <br />k•4'" &"'6 Soft - 4iir7- — 15 <br />Signature Date <br />Comments (including type of equipment and location, per Cz(e), if applicable) <br />❑ Check here 9 attachments. <br />FEMA Form 086-0-33 (12119) replaces all previous editions_ Form Page 4 of 6 <br />