Laserfiche WebLink
ELEVATION CERTIFICATE OMB No. 1660-0008 <br />Expiration Date: November 3Q, 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 />sEcTroN G - coMMUNlTy TNFORMATTON (OPT|ONAL) <br />The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete <br />Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement <br />used in ltems G8-G10. ln Puerto Rico only, enter meters. <br />G1. E The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, <br />engineer, or architect who is authorized by law to certify elevation information. (lndicate the source and date of the elevation <br />data in the Comments area below.) <br />G2. I A c_ommunity official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) <br />or Zone AO. <br />G3. I The following information (ltems G4-G10) is provided for community floodplain management purposes. <br />G4. Permit Number G5. Date Permit lssued G6. Date Certificate of <br />Compliance/Occupancy lssued <br />G7. This permit has been issued for: ! New Construction n Substantial lmprovement <br />G8. Elevation of as-built lowest floor (including basement) <br />of the building: <br />G9. BFE or (in Zone AO) depth of flooding at the building site: <br />G10. Community's design flood elevation: <br />! feet ! meters <br />! feet ! meters <br />! feet ! meters <br />Datum <br />Datum <br />Datum <br />Local Official's Name Title <br />Community Name Telephone <br />Signature Date <br />Comments (including type of equipment and location, per C2(e), if applicable) <br />! Check here if attachments. <br />FEMA Form 086-0-33 (12119)Replaces all previous editions.Form Page 4 of 6