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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 />18401 Salmon la Sac Road <br />City State ZIP Code <br />Company NAIC Number <br />Ronald Washington 98940 <br />SECTION E - BUILDING ELEVATfON INFORMATION (SURVEY NOT REQUIRED) <br />FOR ZONE AO AND ZONE A (WITHOUT BFE) <br />For Zones AO and A (without BFE), complete Items El-E5. If the Certificate is intended to support a LOMA or LOMR-F request, <br />complete Sections A, B,and C. For Items El-E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, <br />enter meters. <br />E1. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below <br />the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). <br />a) Top of bottom floor (including basement, <br />crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. <br />b) Top of bottom floor (including basement, <br />crawlspace, or enclosure) is — ❑ feet ❑ meters above or ❑ below the LAG. <br />E2, For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 1-2 of Instructions), <br />the next higher floor (elevation C2.b in <br />the diagrams) of the building is — ❑ feet ❑ meters ❑ above or ❑ below the HAG. <br />E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. <br />E4. Top of platform of machinery and/or equipment <br />servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. <br />E5. Zone AO only: If 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 ❑ No ❑ Unknown. The local official must certify this information in Section G. <br />SECTION F -- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION <br />The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA-issued or <br />community -issued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge. <br />Property Owner or Owner's Authorized Representative's Name <br />Address City State ZIP Code <br />Signature Date Telephone <br />Comments <br />❑ Check here if attachments. <br />FEMA Form 086-0-33 (12119) Replaces all previous editions. Form Page 3 of 6 <br />