Laserfiche WebLink
IMPORTANT: ln these spaoeg, copy the corresponding information from Section A-FOR INSURANCE GOMPAI'{Y USE <br />Bullding SlreelAddress (including Apt., Unlt, Suite, and/or Bldg. No.) or P.0. Route and Box No <br />3008 Dapple Gray Way <br />Policy Number: <br />City State <br />Washington <br />ZP Code <br />98926Ellensburg <br />Company NAIC Numb€r <br />SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) <br />FOR ZONE.AO AND ZONE A (WTHOUT BFE) <br />For Zones Ao and A <br />complete Seclions A, <br />enter meters. <br />(wlthout BFE), complete ltems E1-E5, lf the Certiticate is intended to support a LOMA or LOMR-F request, <br />B,and C. For ltems E'l-€4, use nafural grade, if evallable. Check the measurement used. ln Puerto Rico only, <br />E1. Pfovide elevation informafion for the following and check the appropriate boxes to show whether the elevation is above or belot/v <br />the highest adjacent grade (HAG) and lhe loweet adjaoent grade (LAG). <br />a) Top of bottom floor (induding basemont, <br />crawlspace, or enclosure) is <br />b) Top of bottom tloor (indudirg basemont, <br />crawlspace, or enclosure) is <br />nfeet n rneters <br />lfeet [meters <br />fl above or ! below the HAG. <br />fl abovs or I bebw the LAG. <br />E2. For Building Diagrams 6-9 with permanenl flood oponings provided in Section A ltems 8 and/or g (see pages 1-Z of lnstruc.tions), <br />the next higher floor (elevation C2,b ln <br />the diagrams) of the building is <br />E3. Alteched garage (top of slab) is <br />E4. Top of platform of machlnery and/or equipmenl <br />servlclng lhe bulldlns ls <br />Ifeet !meters Iaboveor Ebelowthe HAG. <br />! foet ! meters I above or I below the HAG. <br />nfeet n meters fl above or I bebw the HAG. <br />E5. Zone AO only: lf no flood depth number is available, is lhe top of the bottom floor elevaled in accordance wlth the mmmunitfs <br />floodplain management ordinanoe? ! Yes I tto ! Unknown. The local offioial must cerfiIy this information in Section G <br />sEcTtoN F - pRopERw owNER (oR owNER'S REPRESENTATIVE) CERTTFTCATION <br />The property owner or ownefs authorized reprasentatfue who completes Sections A, B, and E lor Zone A (without a FEMAFissued or <br />community-issued BFE) or Zone AO must sign here. The statements in Sectlons A, B, and E are correct to ihe best of my knowledge. <br />Property Owner or Ownefs Authorized Representatlve's Name <br />Scott Henson <br />Address <br />1224 S PioneerWay <br />Gity <br />Moses Lake <br />State <br />Washington <br />ZIP Code <br />98837 <br />Signature <br />-%^ffi'l'---- <br />Date <br />Lt/ t7/soxt- <br />Telephone <br />{509) 855-5112 <br />Comments <br />E Ctreck here if attachments. <br />ELEVATION CERTIFICATE <br />OMB No. {660-0008 <br />Expiration Date: November 3O,2022 <br />FEMA Form 086-0.33 (12/19)Replaoes all provious editions.Form Page 3 ofG