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ELEVATION CERTIFICATE <br />IMPORTANT: MUST FOLLOW THE INSTRUCT|ONS oN PAGES S.lg <br />Rulldlng strset Address {lnc{udlng Apl., unlt, sulle, and/or Bldg. No.}or p.o. Roule and Box No.: <br />2911 Dapple Gray Way <br />Clty: Ellens_9_rJlg_ Stare: -WA ZIP Oods: 98926 <br />FOR INSURANCE COMPANY USE <br />Policy Number; <br />Company NAIO Number: <br />C1. Bullding olovations aro bascd on: ff Conslrucllon Drawings' n Building Under Conslruclion" E Finlshed Corrslrucllon'A n€w Elevstlon Cerlificale wlll be roqulrod whan conslruction of lhe bulldlng ls complelo, <br />(wilh BFE), VE, V1-V30, V (with BFE), AR, AR/A, AR/AE, AFVA1-A3O, AR/AH, <br />lndlcate elevation datum used for lhs elevallon$ ln llems a) through h) bclow.fl NGVD 1e2s El NAVD 1SSS I other: <br />Datum used for building elevallons tnusl tre lhe same ss lhat used for the BFE. Conversion lactor used? <br />lf Yes, describe lhe sourco of lhe convorslon lactor in lhe section D commenls area, <br />a) Top of bottom floor (includlng bassm€nl, crawlspace, or enclosure 0oor); <br />b) Top of lho noxt hlgher floor (See lnstruclions): <br />c) Bottom of the lowssl horizonlol skucturel rnomhor (see lnohucllons): <br />d) Atteched garege (top of slab); <br />e) Lowesl elevatlon of Machlnery and Equlpment {M&E) serviclng tho bulldlng <br />(describe type of M&E and locallon ln Secllon D Commonls ar6a); <br />f) Lowest Ar{acenl Grado (LAG) next to building; f] Naturat [] fmlsneO <br />g) Hlgh€st AdJacent Grade {HAG} next io buitdtng: I Natural E] ftnistreO <br />h) Finlshed LAG al lowest olovatlon of afiached deck or slairs, lncludlng slruclural <br />eupport: <br />@ foot fl meters <br />[ff leel I meters <br />^l <br />//l [_J foot fJ meiers <br />nRtno, <br />ing rneters, <br />N, <br />1,588.00 <br />1,588.00 <br />C2. Elsvallons - Zones A1-A30. n E, AH, AO, A <br />A99, Complete llems C2.a-h below accord lo tho Bulldlng Dlagram specified in ltem AZ. ln puodo Rlco only, enler <br />Benchmark Utllizod; Cenler of S 27, T '18 R 18 E VerllcalDatum: NAVD 19BB <br />1,582:90 flfeetImeters <br />1 ,599.10 <br />1,586.70 <br />I Yes EJ No <br />Clteck the meaeuremenl used: <br />fi teet I meters <br />I laet I meters <br />fl feel fl meters <br />p leet I meters <br />'{v.l*M/k <br />werc latilude and longltude ln section A provlded by a llcensed land surveyor? fi yes I No <br />[JCheck here lf sllachmenls and describe ln the Gommenls area, <br />copy all pages of this Elovatlon certilicato and all altauhmonts for (1) community ofliclal, <br />Tille: Professlonal Land $urveyor <br />Company Name: Western Paclflc Engineerlng & Survoy , lno. <br />Commenls olvzilype Bqulpmonl dnd locallon per <br />of ths hoat pump raised <br />anduz,ei desoripllon <br />Slale: WA ZtpCode: 98837 <br />sourco of conv6rslon taolor ln o{ any atlachmenls): <br />Heat Purnp pad was measured at the top with the bottom an additlonalelght lnchss wllh legs <br />cerllficalionThls lois be sealedand laslgned nd aor rchltoctbyenglnaer,6UrVOyOr,aulhorlzed slate lolawby elovalloncedify <br />lnformallon that lhe lnlarmallon lltlsoncsrftly Cotilflcals besl toellodsrepresenlsmy Iha avallable,dalalnlarprol undersland thal anyslalemenlfalsobeorlinemaypunlshableunderu.s,1B Secllon 1001byimprisonmentCoda, <br />(2) lnsuranco agenUcompany, and (3) bullding ownar <br />Addrsss: 1224 S, Pioneer Way <br />Cortifle/s Name; Rlck Skinnor Llconse Number:436't9 <br />Emall: rsklnfier@wpo765.1023 Exl.: <br />City: Moses <br />Slgnalure: <br />Telephono:,:::;,444- <br />FEMA Form FF-20B"FY-22-152 (formerly 0S6"0-33) (10/22)Page 3 oI 19