Laserfiche WebLink
IMPORTANT: ln these spacss, copy the corispondlng lnformatlon from Seoflon A,FOR INSURANCE COMPANY USE <br />Bulldlng sireet Address (including Apt., Unil, suite, and/or Bldg. No.) or p.o. Route and Box No. <br />2919 Roan Drlve <br />Pollcy Number: <br />State <br />Washington <br />ZIP Gode <br />98926 <br />Clty <br />Ellensburg <br />Gompany NAIC Number <br />For Zones,AO.and A (wllhoulBfE)rcompleleltgms El-Es. lf the Cerlilicate ls lnlonded to support a LOMA or LOMR-F reguest, <br />complete Seotions A, B,and C. For ltems E1-E4, use natural grade, lf avallable. Check the m6isurement ueed. ln puerto F{ico only, <br />enter meters. <br />El. Provide elevation lnloma{ion for the following and chook the appropriale boxes to show whother the elevallon is above or below <br />the highest adjacent grado (HAG) and the toweet adjacent grait6 (LAG). <br />flood openinge provided in Seclion A ltems 8 and/or g (see pageo 1-2 of lnotrucllons), <br />E5. ?ong 49 only: lf no llood depth number is available, ls lhe top ol lhe bottom lloor elevatod ln accordance wlth the oommunitfs <br />floodplaln management ordlnance? ! Yes E No I Unknown. The tocat offioial must certifi this tnformailon tn Seilon G. <br />NOT REOUTRED)SECTION E- BUILDING ELEVATION INFORMATION <br />FORZONE AO AND ZONE A BFE) <br />84. Topof platform of.machlnery and/or equipment <br />sorviclng the bulldlno i6 fiteet flmeters D above or [belowthe HAG. <br />a) Top of bottom floor (inoluding basemont, <br />crawlspace, or enclosure) is <br />b) Top of boltom lloor (lncluding basement, <br />crawlspace, or endosure) ls <br />I teet D meters flabove or ! below the ule. <br />Efeet Imeters !aboveor fJbelowtheLAG. <br />E2, For Buildlng Dlagrams 6-9 with permanent <br />the next hlgher lloor (elevatlon C2.b ln <br />the dlagrams) of the bulldlng le <br />E3. Attached garago (top of slab) is <br />n feet I meters I above or I below the HAG. <br />Efeet Imeters [aboveor f]betowthe HAG. <br />sEcTtoN F - pRopERTy owNER (OR OWNER'S REPRESENTATTVE) CERT|F|CAT| ON <br />The prop.erty ownglqr_o.wnqt's authorlzed representative who completes Seotlons A, B, and E fol Zone A (wilhoul a FEMAlssued or <br />communlty.lssued BFE) or Zone AO muel olgn hele. The statemedts ln Sectlons A, B, and E are correct to the best of my knowledge. <br />Property Owner or Owne/s Authorized Representative's Name <br />Scott Henson <br />Addr€$g <br />12245 PloneerWay <br />crty <br />Moses Leke <br />State <br />Washington <br />ZIP Code <br />98837 <br />.4^o{ "/Jn-.,:-- <br />Date <br />;t./tll /;tc,d.3) <br />Telephone <br />(509) 855-5112 <br />Slgnature <br />il Cnecf here lf eltechments. <br />Comments <br />ELEVATION CERTIFICATE OMB No, <br />Explration <br />1660.0008 <br />Date: November30,2O22 <br />FEMA Form 086-0-39 (121191 Replaces all previous edlllons.Form Page 3 of 6