Laserfiche WebLink
IIvIPORTANT: ln these spacGs, copy the correspondlng lnformatlon from Seaflon 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 />3002 Dapple Gray Way <br />Pollcy Number: <br />State <br />Washlngton <br />ZIP Code <br />s8926 <br />City <br />Ellensburg <br />Company NAIC Number <br />sEcTroN E- BUTLDTNG ELEVATTON TNFORMATTON (SURVEY NOT REQUTRED) <br />FOR ZONE AO AND ZONE A {WTHOUT BFE} <br />ForZones AO and A (wlthout BFE), complete ltems E1-E5. lf the Certiflcate ls lntended to support a LOMA or LOMR.F request, <br />complele Sections A, B,and C. For ltems F1-E4, use natural grade, if avallable. Check lhe measurement used, tn Puerto Rico only, <br />onter metsrs. <br />El. Provlde elevatlon lnformatlon for lhe followlng and oheck lhe approprlate boxes to show whelher the olevallon le above or below <br />tha highest adjacenl grade (HAG) and the lowest adjacent grade (LAG). <br />flood openings provided ln Section A ltems I and/or 9 (see pages 1-2 of lnstructlons), <br />E5. Zone AO only: lf no fiood d€pth number le avallabls, ls the top of the botom floor etevaled ln accordance wlth the communlty's <br />floodplaln management ordlnance? fl Yes I No I Unknown. The local oflioial must certiff this informatlon in Saction G. <br />a) Top of boftom lloor (lncludlng basemont, <br />crawlepace, or enclosure) ls <br />b) Top of bottom lloor (including baaement, <br />crawlspace, or enclosure) ls <br />I fest I meters I above or ! bebw the HAG. <br />D feet I melers I above or fl below the LAG. <br />E4. Top of platform of machlnery and/or equlpment <br />servicing lhe building ls Dfeet I meterE f]aboveor flbolowthe HAG. <br />82. Fot Building Oiagrams 6-9 with psrmanont <br />the neK hlgher floor (elevation C2.b in <br />lhe diagrams) of the bullding is <br />E3. Attachod garago (lop of slab) is <br />E leet fJ meters D above or I below the HAG. <br />Iteet Emeters Daboveor f]belowlhe HAG. <br />sEcTloN F - PROPERTY OWNER (OR OWNER'S REPRE$ENTATIVE) CERT|F|CAT|ON <br />The property ownor or owna/s authorlzed representallve who completes Secllons A. B, and E for Zone A (wlthout a FEMAJssued or <br />communlty-lssued BFE) or Zone AO must sign here. The statemenls in Sections A, B, and E are correct to the bost of my knowledge. <br />Property Owner or Ownefs Authorized Represenlalive's Name <br />Scoft Henson <br />Addrass <br />1224 S Ploneer Way <br />Clty <br />Moses Lake <br />Stete <br />Washlngton <br />ZIP Code <br />98837 <br />5lt (509) 8556112/ <br />! Gheck here if atlachments, <br />Commenls <br />ELEVATION CERTIFICATE OMB No. 1660-0008 <br />Expiration Date: November 30, 2O22 <br />FEMA Form 086-0-33 ('l2l1S')Replaces all previous edilions.Form Page 3 of 6