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24215 76TH AVE W ELEVATION CERTJAN 2 8 2021 U.S. DEPARTMENT OF HOMELAND SECURITY BUILDING OMB No. 1660-0008 Federal Emergency Management Agency Expiration Date: November 30, 2022 National Flood Insurance Program ELEVATION CERTIFICATE Important: Follow the instructions on pages 1-9. Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent/company, and (3) building owner. SECTION A — PROPERTY INFORMATION FOR INSURANCE COMPANY USE Al. Building Owner's Name Policy Number: Brent Smith A2. Building Street Address (including Apt , Unit, Suite, and/or Bldg No.) or P O. Route and Company NAIC Number. Box No. 24215 76th Ave W City State ZIP Code Edmonds Washington 98026 A3. Property Description (Lot and Block Numbers; Tax Parcel Number, Legal Description, etc_) Parcel Number 00488800701901 A4. Building Use (e.g.. Residential, Non -Residential, Addition, Accessory, etc.) Residential A5. Latitude/Longitude: Lat. 47-46-45 Long. -122-20-01 Horizontal Datum: ❑ NAD 1927 I -XI NAD 1983 A6 Attach at least 2 photographs of the building if the Certificate is being used to obtain flood insurance AT Building Diagram Number 9 A8. For a building with a crawlspace or enclosure(s): a) Square footage of crawlspace or enclosure(s) 1272.00 sq ft b) Number of permanent flood openings in the crawlspace or enclosure(s) within 1.0 foot above adjacent grade 8 c) Total net area of flood openings in A8.b 1603.00 sq in d) Engineered flood openings? []Yes ❑ No A9. For a building with an attached garage: a) Square footage of attached garage 490.00 sq ft b) Number of permanent flood openings in the attached garage within 1.0 foot above adjacent grade 0 c) Total net area of flood openings in A9.b N/A sq in d) Engineered flood openings? ❑ Yes ❑ Na SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION 61 NFIP Community Name & Community Number 132. County Name B3. State City of Edmonds 530163 Snohomish Washington B4. Map/Panel B5. Suffix B6. FIRM Index FIRM Panel B8. Flood B9. Base Flood Elevation(s) [B7. Number Date Effective/ Zone(s) (Zone AO, use Base Flood Depth) Revised Date 1315 F 06-19-2020 06-19-2020 I A N/A B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item B9 ❑ FIS Profile ❑ FIRM ❑ Community Determined ❑ Other/Source' B11. Indicate elevation datum used for BFE in Item 89: ❑ NGVD 1929 [] NAVD 1988 ❑ Other/Source: B12. Is the building located in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ❑X No Designation Date: ❑ CBRS ❑ OPA FEMA Form 086-0-33 (12/19) Replaces all preVious editions. Form Page 1 of,,o"''� ELEVATION CERTIFICATE OMB No. 1560-0008 Expiation Date: November 30 2022 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 P.O. Route and Box No. Policy Number: 24215 76th Ave W City State ZIP Code Company NAIC Number Edmonds Washington 98026 SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1 Building elevations are based on ❑ Construction Drawings` ❑ Building Under Construction` Q 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, V1-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 USC&GS O 407 Vertical Datum NAVD 88 Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 ] NAVD 1988 ❑ Other/Source. Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. a) Top of bottom Floor (including basement, craw!space, or enclosure floor) 288A Z feet ❑ meters b) Top of the next higher Floor 291.4 0 feet ❑ meters c) Bottom of the lowest horizontal structural member (V Zones only) ❑ feet ❑ meters d) Attached garage (top of slab) 290.9 feet [] meters e) Lowest elevation of machinery or equipment servicing the budding 290.8 Q feet meters (Describe type of equipment and location in Comments) f) Lowest adjacent (finished) grade next to budding (LAG) 2903 FX� feet ❑ meters g) Highest adjacent (finished) grade next to building (HAG) 290.9 ❑X feet ❑ meters h) Lowest adjacent grade at lowest elevation of deck or stairs, including 288 S �( ❑ 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 elevatior 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 Ll S. Code, Section 1001. Were latitude and longitude in Section A provided by a licensed land surveyor? Ri Yes ❑ No [] Check here if attachments Certifier's Name License Number Src�SsS a'�CS.:Q�siit. Pamala Sager 43618 LY: 1� Title Professional Land Surveyor Company Name�� n Signature Surveying & Mapping, PLLC Address P.O Box 55487 City State ZIP Code = � ,'r.•; ; t�:.. - r �; I Shoreline Washington 98155 , Sigi e Dale Telephone n� lI/Z /Zo (206) 947-4975 F_xt Copy all pages of this Elevation Certificate and all attachments for (1) community official, (2) insurance agent1company, and (3) building owner, Comments (including type of equipment and location, per C2(e), if applicable) C2e - Gas meter C2h - Lowest elevation of property FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 2 of,E'l ELEVA"PION CER-rIFICATE OMB No. 1660-0008 Expiration Date November 30, 2022 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 P 0 Route and Box No Policy Number: 24215 76th Ave W City State ZIP Code Company NAIC Number Edmonds Washington 98026 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 E1-E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, B,and C. For Items E I-E4, use natural grade, if available Check the measurement used. In Puerto Rico only, enter meters E1. Provide elevation information for the following and check the appropriate boxes to snow 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, crawlspace, or enclosure) Is 2.5 Z feet ❑ meters ❑ above or © below the HAG. b) Top of bottom floor (including basement, crawlspace, or enclosure) is _ 1.9 XD feet ❑ meters ❑ above or OX below the LAG E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 andior 9 (see pages 1-2 of instructions), the next higher floor (-elevation C2.b in the diagrams) of the building is 0_5 Z feet ❑ meters LA above or ❑ below the HAG E3 Attached garage (top of slab) is — _ 0.0 Z feet ❑ meters L above or []below the HAG. E4. Top of platform of machinery and/or equipment servicing the building is _ �_� X❑ feet ❑meters ❑above or X❑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? ❑ 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 representative who completes Sections A. B, and E for Zone A (without a FEMA-issued 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 Pamala Sager PLS 43618 Address City State ZIP Code P.0 Box 55487 Shoreline Washington 98155 Signal e j Date Telephone 9 .�p (206) 947-4975 Comments ❑ Check here if attachments. FEMA Form 086-0-33 (12/19) Replaces all previous editions Form Page 3 ov, 3 ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date. November 30, 2022 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 P.O. Route and Box No Policy Number: 24215 76th Ave W City State ZIP Code Company NAIC Number Edmonds Washington 98026 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. ❑ The information in Section C was taken from other documentation that has beer. 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.) G2 ❑ 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—G10) is provided for community floodplain management purposes. G4. Permit Number G5. Date Permit Issued G6. Date Certificate of Compliance/Occupancy Issued G7. This permit has been issued for: ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -built lowest Floor (including basement) ❑ feel ❑ meters of the building: Datum G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum G10. Community's design Flood elevation: ❑ feet ❑ meters Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ❑ Check here if attachments. FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 4 ofX7 BUILDING PHOTOGRAPHS OMB No, 1660-0008 ELEVATION CERTIFICATE See Instructions for Item Ae. Expiration Date' November 30, 2022 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 P 0. Route and Box No. Policy Number. 24215 76th Ave W City State ZIP Code Company NAIC Number Edmonds Washington 98026 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. FEMA Form 086-0-33 (12/19) Replaces all previous editions iF Form Page 5 of� 7 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE Continuation Page Expiration Date November 30, 2022 IMPORTANT: In these spaces, copy the corresponding information from Section A. FOR INSURANCE COMPANY USE Build ng Street Address (including Apt , Unit, Suite, and/or Mg. No.) or P.O Route and Box No Policy Number: 24215 76th Ave W City State ZIP Code Company NAIC Number Edmonds Washington 98026 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 AS. 4I Y FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 6 of 8 7 BUILDING PHOTOGRAPHS OMB No. 1660-0008 ELEVATION CERTIFICATE Continuation Page Expiration Date November 30. 2022 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 P.0 Route and Box No Policy Number 24215 76th Ave W City State ZIP Code Company NAIC Number Edmonds Washington 98026 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 epresentative examples of the Flood openings or vents, as indicated in Section A8. Right 40- Rear View Vents 1 ,nt �ea,-Pnoe�oor- FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page;6"of,8�