BLD2014-0551 ELEV CERTS - ALL 3 INC FINALU.S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY ELEVATION CERTIFICATE
National Flood Insurance Program IMPORTANT: Follow the instructions on pages 1-9.
OMB No. 1660-0008 —1
Expiration Date: July 31, 2015
SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Ardsley Homes, LLC Policy Number:
A2. Build' Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Company NAIC Number:
T934 - 243rd PL SW
City Edmonds state WA ZIP Code 98026
A3. Property Description (Lot and Block Numbers, Tax Parccl Number, Legal Description, etc.)
Lot 6 - plat of Shoreshire, as recorded under Snohomish County Auditor's File No. 201407165001
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential
A5. Latltude/Longitude: Lat. 47 7788* Long. -122,3335* Horizontal Datum: 0 NAD 1927 E] NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) sq ft a) Square footage of attached garage sq ft
b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage
or enclosure(s) within 1.0 foot above adjacent grade Within 1.0 foot above adjacent grade
c) Total net area of flood openings in AB.b sq in c) Total net area of flood openings in A9.b — sq in
d) Engineered flood openings? 0 Yes ONo d) Engineered flood openings? 0 Yes C1 No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Bl. NFIP Community Name & Community Number
B2. County Name
B3. State
Citv of Edmonds 530163
Snohomish
I WA
B4. Map/Panel Number
B5. Suffix
86. FIRM Index Date
B7. FIRM Panel Effective/
B8. Flood Zone(s)
B9. Base Flood Elevation(s) (Zone
Revised Date
AO, use base flood depth)
1
53061C / 1315
E
11/08/1999
11/08/1999
A
286.14 ft
BID. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
0 FIS Profile 0 FIRM E9 Community Determined El Other/Source:
Bll. Indicate elevation datum used for GFE in Item B9: [I NGVD 1929 ER NAVD 1988 C] Other/Source:
812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? [] Yes JR No
Designation Date: — / — / — C] CBRS 0 OPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: Z Construction Drawings* C3 Building Under Construction* [)Flnished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones Al-A30, AE, AH, A (with BFIE), VE, V1430, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AH, AR/AO. Complete Items
C2.a--h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: WCCS SURVEY DATABASE Pt. ID 175 Vertical Datum* NAVD 88
Indicate elevation datum used for the elevations in items a) through h) below. C]NGVD1929 IRNAVD1988 00ther/Source:—
Datum used for building elevations must be the same as that used for the BFE. Ched, the measurement used
a) Top of bottom floor (including basement, crawlspace, or enclosure floor)
b) Top of the next higher floor
c) Bottom of the lowest horizontal structural member (V Zones only)
d) Attached garage (top of slab)
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG)
g) Highest adjacent (finished) grade next to building (HAG)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support
288.
89
N feet
El meters
414
89
X feet
0 meters
-
. -
[] feet
E] meters
287
93
N feet
El meters
289
..43
N feet
0 meters
287
35
N feet
0 meters
287
35
N feet
0 meters
287
35
N feet
C3 meters
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
information. I certify that the information on this Certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
0 Check here If comments are provided on back of form. Were latitude and longitude in Section A provided by a
[__1 Check here if attachments. licensed land surveyor? 0 Yes E] No
CertIfier's Name Charles A. Richardson I License Number 29291
�itle Company Name
Land Surveyor Summit Surveying Inc.
Address city State ZIP Code
12606 - 82nd Ave:4& Kirkland I WA 198034
Signature Date 7 , 31 1 Telephone
b -14 (425) 814-8487
FEMA Form 086-0-33 (Revised 7/12) See reverse side for continuation.
Replaces all previous editions.
U.S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY ELEVATION CERTIFICATE
NoNonal Flood Insurance Program IMPORTANT: Follow the instructions on pages 1-9.
OMB No. 1660-0008
Expiration Date: July 31, 2015
SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Ardsley Homes, LLC Policy Number: I
Apt., Unit, Suite, and/or Bldg. No.) or PO. Route and Box No.
Company NAIC Number:
City Edmonds state WA ZIP Code 98026
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
— Lot 7 - plat of Shoreshire, as recorded under Snohomish County Auditoes File No. 201407165001
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessor)6 etc.) ReSdenual
A5. Latitude/ Longitude: Lat. 47 77-90* Long. -122,3334' Horizontal Datum: C] NAD 1927 N NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number
A8. For a building with a crawlspace or enclosure(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) sq ft a) Square footage of attached garage sq ft
b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage
or enclosure(s) within 1,0 foot above adjacent grade within .1.0 foot above adjacent grade
c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b — sq in
d) Engineered flood openings? El Yes [_1 No d) Engineered flood openings? El Yes E] No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Bl. NFIP Community Name & Community Number
82. County Name
83. State
Citv of Edmonds 530163
Snohomish
I WA
B4. Map/Panel Number
B5. Suffix
B6. FIRM Index Date
B7. FIRM Panel Effective/
B8. Flood Zone(s)
B9. Base Flood Elevation(s) (2one
Revised Date
AO, use base flood depth)
53061C / 1315
E
11/0811999
11/08/1999
A
286.14 ft
810. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
o ns Profile C] FIRM & Community Determined C1 Other/Source:
B11. Indicate elevation datum used for GFE in Item B9: E] NGVD 1929 0 NAVD 1988 0 Other/Source:
812. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? E] Yes IR No
Designation Date: — / — / — E] CBRS C] OPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: Ig Construction Drawings* [I Building Under Construction* EJ Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones Al-A30, AE, AH, A (with BFE), VE, Vl-V30, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AH, AR/AO. Complete Items
C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: WCCS SURVEY DATABASE Pt. ID 175 Vertical Datum- NAVQ 88
Indicate elevation datum used for the elevations in items a) through h) below. C]NGVD1929 EONAVD1988 00ther/Source:
Datum used for building elevations must be the same as that used for the BFE. r1k L, #1, , - �t 14
a) Top of bottom floor (including basement, crawlspace, or enclosure floor)
b) Top of the next higher floor
c) Bottom of the lowest horizontal structural member (V Zones only)
d) Attached garage (top of slab)
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments)
0 Lowest adjacent (finished) grade next to building (LAG)
g) Highest adjacent (finished) grade next to building (HAG)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support
288.62
e meast,
N feet
e e use
[I meters
414
62
IN feet
0 meters
0 feet
El meters
287
66
0 feet
0 meters
289
16
9 feet
0 meters
287
08
OR feet
0 meters
287
08
X feet
0 meters
287
08
9 feet
El meters
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
Tki, ;4;+; il - 1�1 li-A 14 -1-1 k � 14 i. - -hit-t -th-i-I h� I- t� rfif. .1-ti-
FEMA Form 086-0-33 (Revised 7/12) See reverse side for continuation. Replaces all previous editions.
0 C T I "' 2017
(5L, D -74D I L4 - 0 55 )
U.S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
Natlimol Flool hisurance Proqfain
ELEVATION CERTIFICATE
IMPORTANT: Follow the instructions on pages 1-9.
OMB No. 1660-0008
Expiration Date: July 31, 2015
SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Ardsley Homes, LLC Policy Number
A2. Buildin Street Address (including Apt., Unit, Suite, arid/or Bldg. No.) or PO. Route and Box No. Company NAIC Number:
7934 - 243rd PL SW I I
City Edmonds State WA ZIP Code 98026
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lot 6 - plat of Shoreshire, as recorded under Snohomish County Auditors File No- 201407165001
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) — .
.5idential
A5. Latitude/ Longitude: Lat. 47 7788* Long. Horizontal Datum: C, NAD 1927 NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 9
A8. For a building with a crawlspace or enclostire(s): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) 1455 sq ft a) Square footage of attached garage 564 q ft
b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage
or enclosure(s) within 1.0 foot above adjacent grade 15 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 735 sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? n Yes NNo d) Engineered flood openings? El Yes M No
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
Bl. NFIP Community Name & Community Number
B2. County Name
B3. State
Citv of Edmonds 530163
Snohomish
I WA
B4. Map/Panel Num
lj�� Suffix
!x Date
B7. FIRM Panel Effective�/
B8. Flood Z
9. Base Flood Elevation(s�(Zon�
Revised Date
AO, use base flood depth)
53061C / 1315
E
999
11/08/1999
A
286.14 ft
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Itern 09',
El FIS Profile El FIRM t0 Community Determined F1 Other/SOUrce: __._
Bll. Indicate elevation daturn used for BFE in Item 89: El NGVD 1929 X NAVD 1988 El Other/Source:
B12. Is the building located in a Coastal Barrier Resources Systern (CBRS) area or Otherwise Protected Area (OPA)? 0 Yes XNo
Designation Date: — / / — 0 CBRS El OPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: 0 Construction Drawings* X Building Under Construction" Finished construction
'A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones Al-A30, All, AH, A (with BFE), VE, VI-V30, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AH, AR/AO. Complete Items
C2-a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: �NCC�. SURVEY DATABASE Pt. ID 175 Vertical Datum: NAVD 88
Indicate elevation datum used for the elevations in items a) through h) below. [I NGVD 1929 IM NAVD 1988 El Other/Source:
Datum used for building elevations must be the same as that used for the BFE.
a) Top of bottom floor (including basement, crawlspace, or enclosure floor)
286.88
Cheen me Measurement
9 feet
used.
El meters
b) Top of the next higher floor
289 89
D9 feet
El meters
c) Bottom of the lowest horizontal structural mernber (V Zones only)
. ..... . ... . ..
feet
meters
d) Attached garage (top of slab)
289 45____
X feet
meters
e) Lowest elevation of machinery or equipment servicing the building
N feet
El rrieters
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG)
288 34
N feet
0 meters
g) Highest adjacent (finished) grade next to building (HAG)
289 35
IN feet
EJ meters
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
feet
[] meters
structural support
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
Information. i certify that the information on this Certificate represents my best efforts to interpret the data available.
understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
0 Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a
F1 Check here if attachments. licensed land surveyor? 0 Yes E] No
Certifier's Name Charles A. Richardson I License Number 29291
TiiWe Land Surveyor Company Name Summit Surveying Inc.
Address city State Z;P Code
— 12606 - 82nd Ave. NE Kirkland WA 198034
signature Date Telephone
-A (425) 814-8487
SCANNED
PrT i 2017
U.S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY ELEVATION CERTIFICATE OMB No. 1660-0008
Notionol Flood Imsuranct Program IMPORTANT: Follow the instructions on pages 1-9. Expiration Date: July 31, 2015
SECTION A - PROPERTY INFORMATION FOR INSURANCE COMPANY USE
Al. Building Owner's Name Ardsley Homes, LLC Policy Number:
A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or RO. Route and Box No. Company NAIC Number:
34 - 243rd PL SW
City Edmonds State WA ZIP Code 98026
A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.)
Lot 6 - plat of Shoreshire, as recorded under Snohomish County Auditors File No. 201407165001
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential
A5. Latitude/ Longitude: Lat. 47 7788' Long. _-122.3�35' Horizontal Datum: 0 NAD 1927 Ox NAD 1983
A6. Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance.
A7. Building Diagram Number 9
A8. For a building with a crawlspace or enclosure(s): AS. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) 1455 _ q ft a) Square footage of attached garage 564 q ft
b) Number of permanent flood openings in the crawlspace b) Number of permanent flood openings in the attached garage
or enclosure(s) within 1.0 foot above adjacent grade 15 within 1.0 foot above adjacent grade 0
c) Total net area of flood openings in A8.b 735 sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? El Yes [9 No d) Engineered flood openings? El Yes NNo
SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
81. NFIP Community Name & Community Number
82. County Name
B3. State
Citv of Edmonds 530163
Snohomish
I WA
84. Map/Panel Number
B5. Suffix
B6. FIRM Index Date
87. FIRM Panel Effective/
B8. Flood Zone(s)
69. Base Flood Elevation(s) (Zone
Revised Date
AO, use base flood depth)
53061C / 131
E
11/08/1999
11/08/1999
A
286.14 ft
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9:
El FIS Profile El FIRM X Community Determined F-1 Other/Source:
811. Indicate elevation datum used for BFE in Item B9: [J NGVD 1929 X NAVID 1988 E] Other/Source:
B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)?
El Yes Dd No
Designation Date: El CEIRS OPA
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: [] Construction Drawings* E] Building Under Construction* DI Finished Construction
*A new Elevation Certificate will be required when construction of the building is complete.
C2. Elevations - Zones Al-A30. AE, AH, A (with BFE), VE, V1430, V (with BFE), AR, AR/A, AR/AE, AR/Al-A30, AR/AK, AR/AO. Complete Items
C2.a-h below according to the building diagram specified in Item A7. In Puerto Rico only, enter meters.
Benchmark Utilized: WCCS SURVEY DATABASE Pt. ID 175 Vertical Datum: NAVQ 88
Indicate elevation datum used for the elevations in items a) through h) below. []NOVD1929 MNAVD1988 E]Other/Source:—
Datum used for building elevations must bethe same as that used for the BFE. n6 I � A
a) Top of bottom floor (including basement, crawlspace, or enclosure floor)
b) Top of the next higher floor
c) Bottom Of the lowest horizontal structural member (V Zones only)
d) Attached garage (top of slab)
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments)
f) Lowest adjacent (finished) grade next to building (LAG)
g) Highest adjacent (finished) grade next to building (HAG)
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
structural support
ec e measuremen
— .
286
88
feet
0 meters
289
89
feet
[__1 meters
N/A
_
N feet
El meters
289
45
9 feet
E3 meters
291
..20
Z feet
El meters
289 00 X feet 0 meters
289 60 N feet El meters
N/A — N feet ED meters
SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION
This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation
Information. / certify that the information on this Certificate represents my best efforts to interpret the data available.
I understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
* Check here if comments are provided on back of form. Were latitude and longitude in Section A provided by a
(ST
* Check here if attachments. licensed land surveyor? IX Yes [I No
1 :t4
29291
--..I
L
'0z 4-
Certifier's Name
Charles A. Richardson
License Number
29291
Title Land Surveyor
Company Name Summit Surveying Inc.
Address
- 82nd Ave. NE
city
Kirkland
State
WA
ZIP Code
198034
,e::�2606
Signature
Date
Telephone
(425)814 -8487
ELEVATION CERTIFICATE, page 2
IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or PO, Route and Box No. Policy Number:
7534 - 243rd PL SW
City State ZIP Code Company NAIC Number:
Edmonds WA 98026
SECTION D — SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED)
Copy both sides of this Elevation Certificate for (1) community official, (2) insurance agent/company, and (3) building owner.
Comments
Section C2.e Elevation measured on top of hot water heater platform on floor of garage.
Signature Date o2 Lof 415-
SECTION E — BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without BFE), complete Items EI—E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B,and C,
For Items Ei-114, use natural grade, if available. Chock the measurement used. In Puerto Rico only, enter meters.
El. Provide elevation information for the following and check the appropriate boxes to show 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, crawispace, or enclosure) is — [:]feet E] meters E] above or E:) below the HAG.
b) Top of bottom floor (including basement, crawlspace, or enclosure) is - E) feet 1:1 meters El above or 0 below the LAG.
E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 8-9 of Instructions),
the next higher floor (elevation C2.b in the diagrams) of the building is E]feet []meters C] above or E] below the HAG.
E3. Attached garage (top of slab) is []feet El meters E] above or F1 below the HAG.
E4. Top of platform of machinery and/or equipment servicing the building is [I feet El meters El above or 1:1 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 community's floodplain management
ordinance? E] Yes C] No El 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 representative who completes Sections A, B, and E for Zone A (without a FEMAissued or community -issued BFE) or
Zone AO must sign here. The statements in Sections A, B, and E are correct to the best of my knowledge.
Property Owner or Owner's Authorized Representative's Name
Address city State ZIP Code
Signature Date Telephone
Comments
E] Check here if attachments.
SECTION G — COMMUNITY INFORMATION (OPTIONAL)
The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and
G of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement used in Items G8—G10. In Puerto Rico only, enter meters.
G1. 171 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 law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.)
02. 0 A community official completed Section E for a building located in Zone A (without a FEMA-Issued or community -issued BFE) or Zone AO.
G3. [-] The following information (Items G4—G:LO) is provided for community floodplain management purposes.
04. Permit Number G5. Date Permit Issued G6. Date Certificate Of Compliance/Occupancy Issued
G7. This permit has been issued for: E] New Construction 0 Substantial Improvement
G8. Elevation of as -built lowest floor (including basement) of the building: L1 feet E] meters Daturn
09, BFE or (in Zone AO) depth of flooding at the building site: El feet El meters Datum
GIO. Community's design flood elevation: El feet EJ meters Datum
Local Official's Name Title
Community Name Telephone
Signature Date
Comments
Check here if attachments.
FEMA Form 086-0-33 (Revised 7/12) Replaces all previous editions.
ELEVATION CERTIFICATE, page 3 BUILDING PHOTOGRAPHS
See Instructions for Item A6,
IMPORTANT: In these spaces, copy the corresponding Information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or PO. Route and Box No. Policy Number:
7534 - 243rd PL SW I
City State ZIP Code Company NAIC Number:
Edmonds WA 98026 1 1
If using the Elevation Certificate to obtain NFIP flood insurance, affix at least 2 building photographs below according to the instructions
for Item A6. Identify all photographs with date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left
Side View." When applicable, photographs must show the foundation with representative examples of the flood openings or vents, as
indicated in Section A8. If submitting more photographs than will fit on this page, use the Continuation Page.
ELEVATION CERTIFICATE, page 4 BUILDING PHOTOGRAPHS
Continuation Page
IMPORTANT* In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE
Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or PO. Route and Box No. Policy Number:
7534 - 243rd PL SW
City State ZIP Code Company NAIC Number:
Edmonds WA 98026 1 1
If submitting more photographs than will fit on the preceding page, affix the additional photographs below. Identify all photographs with:
date taken; "Front View" and "Rear View"; and, if required, "Right Side View" and "Left Side View." When applicable, photographs must
show the foundation with representative examples of the flood openings or vents, as indicated in Section A8.