Laserfiche WebLink
ELEVATION CERTIFIGATE OMB No. 1660-0008 <br />Expiration Date: November 30,2022 <br />IMPORTANT: ln these spaces, copy the corresponding information from Section A.FOR INSURANCE COMPANY USE <br />Building street Address (including Apt., Unit, suite, and/or Bldg. No.) or P.o. Route and Box No. <br />18401 Salmon la Sac Road <br />Policy Number: <br />City <br />Ronald <br />State <br />Washington <br />ZIP Code <br />98940 <br />Company NAIC Number <br />sEcTtoN E - BUTLDTNG ELEVATION TNFORMATTON (SURVEY NOT REQUTRED) <br />FOR ZONE AO AND ZONE A (W|THOUT BFE) <br />For Zones AO and A (without BFE), complete ltems E1-E5. lf the Certiflcate is intended to support a LOMA or LOMR-F request, <br />complete Sections A, B,and C. For ltems E1-E4, use natural grade, if available. Check the measurement used. ln 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 <br />b) Top of bottom floor (including basement, <br />crawlspace, or enclosure) is <br />! feet ! meters I above or ! below the HAG <br />! feet ! meters ! above or ! below the LAG. <br />E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A ltems 8 and/or 9 (see pages 1-2 of lnstructions), <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 />servicing the building is <br />! feet ! meters <br />! feet ! meters <br />Eteet n meters <br />! above or f below the HAG. <br />I above or ! below the HAG. <br />! above or I 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 I No ! Unknown. The local official must certify this information in Section G <br />sEcTroN F - pRopERTy owNER (OR OWNER'S REPRESENTATTVE) CERT|F|CATION <br />The prop.erty owner or owner's aulhorized 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 />I Cne* here if attachments. <br />FEMA Form 086-0-33 (12119)Replaces all previous editions.Form Page 3 of 6