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ELEVATION CERTIFICATE <br />OMB No. 1660-0008 <br />Expiration Date: November 30, 2022 <br />IMPORTANT: In these spaces, copy the corresponding 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 />1803 SR 970 <br />City State ZIP Code <br />Company NAIC Number <br />Cie Elum Washington 98922 <br />SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) <br />C1. Building elevations are based on: ❑ Construction Drawings` ❑ Building Under Construction* ❑ Finished Construction <br />*A new Elevation Certificate will be required when construction of the building is complete. <br />C2. Elevations — Zones Al A30, AE, AH, A (with BFE), VE, V1—V30, V (with BFE), AR, ARIA, ARIAE, AR/Al—A30, AR/AH, AR/AO, <br />Complete items C2.a—h below according to the building diagram specified in Item AT In Puerto Rico only, enter meters. <br />Benchmark Utilized: Vertical Datum: <br />Indicate elevation datum used for the elevations in items a) through h) below. <br />❑ NGVD 1929 ❑ NAVD 1968 ❑ Other/Source: <br />Datum used for building elevations must be the same as that used for the BFE. <br />Check the measurement used. <br />a) Top of bottom floor (including basement, crawispace, or enclosure floor) __� _ ❑ feet ❑ meters <br />b) Top of the next higher floor ❑ feet ❑ meters <br />c) Bottom of the lowest horizontal structural member (V Zones only) ❑ feet ❑ meters <br />d) Attached garage (top of slab) ❑ feet ❑ meters <br />e) Lowest elevation of machinery or equipment servicing the building <br />(Describe type of equipment and location in Comments) E]feet ❑ meters <br />f) Lowest adjacent (finished) grade next to building (LAG) ❑ feet ❑ meters <br />g) Highest adjacent (finished) grade next to building (HAG) ❑ feet ❑ meters <br />h) Lowest adjacent grade at lowest elevation of deck or stairs, including <br />structural support Elfeet ❑ meters <br />SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION <br />This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. <br />I certiry that the information on this Certificate represents my best efforts to interpret the data available. 1 understand that any false <br />statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001. <br />Were latitude and longitude in Section A provided by a licensed land surveyor? ❑ Yes ❑ No ❑ Check here if attachments. <br />Certifier's Name License Number <br />Title <br />Place <br />Company Name <br />Seal <br />Here <br />Address <br />City State ZIP Code <br />Signature Date Telephone Ext. <br />Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agenticompany, and (3) building owner. <br />Comments (including type of equipment and location, per C2(e), if applicable) <br />FEMA Form 086-0-33 (12119) Replaces all previous editions. Form Page 2 of 6 <br />