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ELEVATION CERTIFICATE OMB No. 1660-0008 <br />Expiration Date: November 30,2022 <br />IMPORTANT; ln these spaces, copy the coresponding information from Section A.FOR INSURANCE COMPANY USE <br />Building Street Address (including Apt., Unil, Suite, and/or Bldg. No.) or P.O. Route and Box No <br />1803 SR 970 <br />Policy Number: <br />City <br />Cle Elum <br />State <br />Washington <br />ZIP Code <br />98922 <br />Company NAIC Number <br />sEcTroN c - BUTLDTNG ELEVATTON TNFORMATTON (SURVEY REQUTRED) <br />C1. Building elevations are based on: I Construction Drawings* [ AuitOing Under Construction* [ FinistreO Conslruction <br />*A new Elevation Certificate will be required when construclion of lhe building is complete, <br />C2. Elevations - Zones A1-A30, AE, AH, A (with BFE), VE, V1-V30, V (with BFE), AR, AR/A, AR/AE, AR/A1-A30, AR/AH, ARIAO. <br />Complete ltems C2.a-h below according to the building diagram specified in ltem 47. ln Puerto Rico only, enter melers. <br />Benchmark Utilized: Vertical Datum: <br />lndicate elevation datum used for the elevations in items a) through h) below. <br />n rucvo 1929 [ NAVD 1988 f]other/Source <br />Datum used for building elevations must be the same as thai used for the BFE <br />Check the measurement used <br />a) Top of bottom floor (including basemenl, crawlspace, or enclosure floor) <br />b) Top oflhe next higher floor <br />c) Bottom of the lowest horizontal structural member (V Zones only) <br />d) Attached garage (top of slab) <br />e) Lowest elevation of machinery or equipment servicing the building <br />(Describe lype of equipment and location in Comments) <br />f) Lowest adjacent (finished) grade next lo building (LAG) <br />g) Highest adjacent (finished) grade next to building (HAG) <br />h) Lowest adjacent grade at lowest elevation of deck or stairs, including <br />slructural supporl <br />I feet <br />fl teet <br />I feet <br />I feet <br />! meters <br />fl meters <br />I meters <br />fl meters <br />fl feet <br />I feet <br />I feet <br />I meters <br />f] meters <br />! meters <br />I feet f] 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 certiff elevation information. <br />I cedify that the information on this Ceftificate represents my best efforts to interpret the data available. I understand that any false <br />statement may be punishable by fine or imprisonment under tB U.S. Code, Section 1001. <br />Were latitude and longitude in Section A provided by a licensed land surveyorf f] yes fJ No I Ctrect here if attachments. <br />Certifieds Name License Number <br />Place <br />$emfi <br />l'{es'e <br />Tiile <br />Gompany Name <br />Address <br />City State ZIP Code <br />Signature Date Telephone Ext. <br />Copy all pages of this Elevation Certilicate and all attachments for (1) community official, (2) insurance agenUcompany, and (3) building owner, <br />Comments (including type of equipmenl and location, per C2(e), if applicable) <br />FEMA Form 086-0-33 (12119)Replaces all previous editions Form Page 2 of 6