Laserfiche WebLink
IMPORTANT: ln lhese spacea, copy lhe corresponding information from Sectlon A,FOR INSURANCE COMPANY USE <br />Building Slreet Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No <br />3006 Dapple Gray Way <br />Policy Numbor: <br />City Stale <br />Washington <br />ZIP Code <br />98926Ellonsburg <br />Company NAIC Number <br />sEcTroN E - BUILDING ELEVATTON TNFORMATTON (SURVEY NOT REQUTRED) <br />FOR ZONE AO AND ZONE A (W|THOUT BFE) <br />For Zones AO and A (wilhout BFE), complele ltems E1-E5. lf the Certificate is intended lo suppod a LOMA or LOMR-F requesl, <br />complele Soctions A, B,and C. For ltems E1-E4, use nalural grade, if available, Ghock lhe measurement used. ln Puerto Rico only, <br />enler meters. <br />E1. Provide elevalion informalion for the followlng and check lhe appropriate boxos to show whelhor lhe elevalion l$ above or below <br />the highest adJacent grade (HAG) and lhe lowesl adJacent grade (LAG). <br />a) Top of boltom floor (including basemenl, <br />crawlspace, or enclosure) ls <br />b) Top of bottom floor (includlng basemenl, <br />crawlspac€. or enclosure) ls <br />fl feet I melers I above or f] below lhe HAG. <br />I feel I meters I above or I below the LAG. <br />E2. For Building Diagrams 6-9 with permanonl llood <br />the next higher lloor (elevation C2.b in <br />lhe diagrams) of lhe bullding ls <br />E3. Atlaohed garage (top of slab) is <br />E4. Top of platform of machlnery and/or egulpment <br />serviclng lhe bullding is <br />openings provided in Seclion A llems B and/or 9 (soe pages 1-2 of lnslructions), <br />lfeet flmeters !aboveor flbebwlhe HAG. <br />Ifeel Imeters Iaboveor flbdowlheHAG. <br />flfeel Imoters Iaboveor flbelowlheHAG. <br />E5. Zone AO only: lf no llood depth number is available, ls the lop of the bottom floor elevaled ln accordance wilh the communily's <br />lloodplain management ordinance? ! Yes fl No f] Unknown. The locsl oflicial musl cerlify lhis informallon in Seclion G. <br />sEcTloN F- PROPERTY OWNER (OR OWNER'S REPRESENTATTVE) CERT|F|CAT|ON <br />The property owner or owne/s aulhorized representalive who completes Sections A, B, and E tor Zone A (wllhout a FEMA-lssuod or <br />community-lssuod BFE) or Zone AO musl slgn here. The statemenls ln Seclions A, B, and E are correct to the best of my knowledge. <br />Proporly Owner or Owne/s Authorlzed Representalive's Name <br />Scotl Henson <br />Address <br />1224 S PloneerWay <br />Cily <br />Moses Lake <br />Slale <br />Washington <br />ZIP Code <br />98837 <br />Slgnature <br />--K-zhlor^r-- <br />Date <br />I /J-i /**z <br />Telephone <br />(509) 855-51 12 <br />Comments <br />f] Ctreck hero if attachmenls. <br />ELEVATION CERTIFIGATE OMB No. 1660-0008 <br />Expiralion Date: November 30,2022 <br />FEMA Form 086-0-33 (12119)Replaces all previous edilions.Form Page 3 of 6