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I= ZIP Code 98740 WCopy both sides of this Elevation Certificate for (1) community official, (2) Incurance agentloompany, and (3) building owner. Comments WASHER AND DRYER AT 12 FT. ELEVATION 3.8.2011 For Zones AO and A (without BFE), complete Items EI -E5. It the Certificate Is Intended to support a LOMA or LOMR-F request, complete Sections A. B, and C. For Items Et -E4, use natural grade, O available. Check the measurement used. In Puerto Rico only, enter meters. Et. Provide elevation Information for the following and check the appropriate boxes to Naw whether the elevation Is above or below the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). a) Top of bottom floor (including basement, cxawlspace, or enclosure) Is _ _ ❑feet ❑maters ❑above orbelow the HAG. b) Top of bottom floor (Including basement. crawlspace, or enclosure) is _ _ ❑_feet ❑meters ❑above or ®below the LAG. E2, For Building Diagrams 8-9 with permanent flood openings provided In Secdgp,,p-Items ii for 9 (see pares 9-9 of Instructions), the nett higher floor (elevation C2.b In the diagrams) of the building Is _ [:]feet U meters FJ above or, u below the HAG. E3. Attached garage (top of elab) Is _ [3 feel [:]meters ❑ above or [:]below gra HG. E4. Top of platform of machinery and/or equipment servicing the building Is _ ❑ feet ❑ meters ❑ above or ❑ below the HAG. E5. Zone AO only:, If no flood depth number is available, Is the top of the bottom floor elevated In accordance with the communWs floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this Information In Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized represerdetive who completes Sections A, B, and E for Zone A (without a FEMA -Issued or communiyassued BFE) or Zone AO must sign here. The statements In Sections A, d and E are coned b tics best ofmy bawbclge. Property Owner's or Owner's Authorized Representative's Name i eiepnone Comments ZIP and G of this Elevation Certificate. Complete the applicable items) and sign below. Check the measurement used In Items GO and G9. G1. ❑ The Information In Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who Is authorized by few to certify elevation Informa0on. (Indicate the source and date of the elevation date In the Comments area below.) G2. ❑ A community official completed Section E for a building bossed In Zone A (wheal a FEMA -Issued or community4asued BFE) or Zone AO. G3. ❑ The following Information (Items G4 -G9) Is provided for community floodplain management purposes. G4. Permit Number G5. Date Persil Issued G8. Date Certificate Of Compllanka/Occupancy Issued G7. This permit has been Issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as-0ult lowest floor (Including basement) of the building ❑ feet ❑ meters (PR) Datum G9. BFE or (In Zone AO) depth of flooding at the building site ❑feet ❑ meters (PR) Datum G10. Community's design flood elevation ❑ feet ❑ meters (PR) Datum Local final Certificate and rive