Laserfiche WebLink
IMPORTANT: ln theee apaces, copy the correspondlng information from Secllon A.FOR INSURANCE COMPANY USE <br />Building StreetAddress (lncludlng Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. <br />2915 Roan Drive <br />Pollcy Numben <br />clty Stale <br />Washington <br />ZIP Code <br />98926Ellonsburg <br />Company NAIC Number <br />sEcTroN E- BUIJING ELEVATION TNFORMATTON (SURVEY NOT REQUTRED) <br />FOR ZONE AO AND ZONE A (WITHOUT BFE) <br />ForZones AO and A (wllhout BFE), complete lteme E1-E5, lf the Cedlllcate is lntended to support a LOMA or LOMR-F requesl, <br />complete Seclions A, B,and C. For ltems E1-E4, use natural grade, if available. Check the measurement ueed, ln Puerto Rlco only, <br />enler rneters. <br />E1. Provlde elevatlon infomatlon for lhe following and chsok the epproprlate boxes to show whether the elevation is above or below <br />the highest adjacenl grade (HAG) and the lowest adJacent grade (LAG). <br />a) Top of bottom floor (inaludlng basoment, <br />crawlspace, or enclosure) ls <br />b) Top of bottom floor (including basemenl, <br />orawlspace, or enolosure) ls <br />D feet D meters I above or E bdow the HAG. <br />! leel I meters f] above or I below lhe LAG. <br />E2, For Bullding Diagrams 6-9 wlth permanent <br />the next higher lloor (elevation C2.b ln <br />lhe dlagrams) of lhe bulldlng ls <br />83. Aftached garage (top of slab) is <br />flood openings provided ln Secllofi A ltems 8 and/or 9 (see pages 1*2 ol lnstrucllons), <br />Efeet E metere Iaboveor EbelowtheHAG. <br />E feet flmeterr I aboveor Ebelowthe HAG. <br />E4. Top of platform of machlnery and/or equlpment <br />sewicing lhe buildlng ls flfeet E meters flabovoor lbelowthe HAG. <br />E6, Zono AO only lf no llood depth numbor [s available, is lhe top of lhe bottom floor elevated ln accodanoe with lho community's <br />floodplaln management ordinance? [ Yes I No I Unknown, The local official must certlfr this informatlon ln Section G. <br />SECT|ON F - PROPERW OWNER (OR OWNER'S REPRESENTATIVEI CERTIFICATION <br />The property owner or owner's authorlzed representative who completes Secllons A, B, and E forZone A (wlthout a FEMA-lssued or <br />community-[eeued BFE) orZone AO must slgn here. The etalemerils in Sectlons A, B, and E are coneot to the best of my knowledge. <br />Pmperty Owner or Owner's Aulhorlzed Repreeentallvo's Name <br />Scott Henson <br />Address <br />1224 S PioneorWay <br />City <br />Moees Lake <br />State <br />Washington <br />ZIP Code <br />98837 <br />Slgnaturo <br />.,9-" ^"{.1- <br />" "}l p. , , ^-, <br />Date <br />',t/(f fto;,>:: <br />Telephone <br />(50e) 855-6112 <br />Comments <br />U Cheok here if atlaohments. <br />ELEVATION CERTIFICATE OMB No. <br />Explration <br />1660-0008 <br />Date: November3o,2022 <br />FEMA Form 086-0-33 (12115')Replaces all previous edltlons.Form Page 3 of6