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IIIPORTANT: ln these spaces, copy the corresponding information lrom Sscllon A.FOR INSURANCE COMPANY USE <br />Building Steet Address (including Apt. <br />480 CEDAR COVE RD. <br />Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.Policy Number: <br />City State <br />WashingtonELLENSBURG 98926 <br />Company NAIC Number <br />SECTION E - BUILDING ELEVATION INFORilATION (SURVEY NOT REAUTRED) <br />zoNE A (W|THOUT BFE)FORZONE AOAND <br />For Zones AO and A (without BFE), complete ltems E1-E5. lf the Certificate is intended to supporl a LOMA or LOMR-F request, <br />complete Sections A, B,and C. For ltems E1-E4, use natural grade, if available. Check the measuremenl used. ln Puerlo iico only, <br />enter meters. <br />E I - Provide elevalion information lor lhe following and check lhe appropriate boxes to show whether the elevation is above or belowthe highest adjacent grade (HAG) and the lowest adjacent g.ade (LAG). <br />a) Top of bottom floor (including <br />crawlspace, or endosure) is <br />b) Top of boltom floor (including <br />crawlspace, or enclosure) is <br />basement, <br />bssement, <br />I feet I meters n above or I below the HAG. <br />I feet ! meters f] above or I below the LAG. <br />E2. For Building Diagrams G-9 with permanent flood <br />the next higher floor (elevation C2.b in <br />the diagrams) of the building is <br />E3. Attached garage (top of slab) is <br />E4. Top of platform of machinery and/or equipment <br />serviong the building is <br />openings provided in Section A ltems 8 and/or g (see pages 'l-2 of lnslruclions), <br />I feet f] meters fl above or f] betow the HAG. <br />fl feet I meters ! above or I below the HAG. <br />f]feet I meters f] above or f]below the HAG. <br />E5" Zone AO only: lf no flood depth number is available, is the top of the bottom floor elevated in accordance with the community's <br />floodplain management ordinance? [ yes n No ! Unknown. The local official must certify this informalion in Seition G. <br />sEcTloN F - PROPERW OWNER (OR OWNER.S REPRESEI{TAnVE) CERnFtCAnoN <br />The property owner or_gwner's aulhorized represenlalive who completes Seclions A, B. and E for Zone A (wiihout a FEMA-issued orcommunity-issued BFE) or Zone AO musl sign here. The statements in Sections A, B, and E are correct to' the best of my knowledge. <br />Property Owner or Ot^rne/6 Authorized Represenlalive's Name <br />Address City State ZIP Code <br />Signature Date Telephone <br />Comments <br />I Check here if attachments. <br />ELEVATION CERTIFIGATE OMB No. 166G0008 <br />Expiration Date: Novcmber 30, 2O22 <br />FEMA Form 086-0-33 (12l19)Replaces all previous editions.Form Page 3 of 6