20150226163336499U.S. DEPARTMENT OF HOMELAND SECURITY
FEDERAL EMERGENCY MANAGEMENT AGENCY
National Flood Insurance Program
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:
Street Address mcludm Apt., Unit, Suite and/or Bldg.No. or P.O. Route and Box No. Company NAIC Number:
A2. Building S_ .0 _... g p •� � / )
1yyL — 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 Auditor's File No. 201407165001
A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential
A5. Latitude/Longitude: Lat. 47 77AW Long. -122 3334° Horizontal Datum: ❑ NAD 1927 ❑x 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): A9. For a building with an attached garage:
a) Square footage of crawlspace or enclosure(s) 1,598 sq ft a) Square footage of attached garage 578 sq ft
b) Number of permanent flood openings in the crawlspace 16 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 8
783
c) Total net area of flood openings in A8.b sq in c) Total net area of flood openings in A9.b 0 sq in
d) Engineered flood openings? ❑ Yes N No d) Engineered flood openings? ❑ Yes N No
&V^V nw1 0 _ OF - hoar iRAIMCE RATE MAP (FIRM) INFORMATION
81, NFIP Community Name & Community Number
B2. County Name
B3. State
WA
Citv of Edmonds 630163
84. Map/Panel Number 85. Suffix 66. FIRM Index Date
Snohomish
B7. FIRM Panel Effective/
B8. Flood Zone(s) B9. Base Flood Elevation(s) (Zone
AO, use base flood depth)
53C / 1315 E 11/08/1999
Revised Date
11/08/1999
A 1 286.14 ft
B10. Indicate the source of the Base Flood Elevation (BFE) data or base flood tiepin U11-feu „, 1 M,
❑ FIS Profile ❑ FIRM ® Community Determined ❑ Other/Source:
B11. Indicate elevation datum used for BFE in Item B9: ❑ NGVD 1929 ® NAVD 1988 ❑ Other/Source:
812.Is the building located in.a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ® No
Designation Date: / / ❑ CBRS ❑ OPA
SECTION C — BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
Cl. Building elevations are based on: ❑ Construction Drawings* ❑ Building Under Construction* gg 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/A1-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 d
Indicate elevation datum used for the elevations in items a) through h) below. ❑ NGVD 1929 N NAVD 1988 ❑ Other/Source:
Datum used for building elevations must be the same as that used for the BFE. Check the measurement used. G c
aj Top of bottom floor (including basement, crawlspace, or enclosure floor)
286.20
14
b) Top of the next higher floor
c) Bottom of the lowest horizontal structural member (V Zones only)
_
NI A
NIA NIA NI
d) Attached garage (top of slab)
288 93
e) Lowest elevation of machinery or equipment servicing the building
(Describe type of equipment and location in Comments)
287 10
f) Lowest adjacent (finished) grade next to building (LAG)
288 80
g) Highest adjacent (finished) grade next to building (HAG)
N/A
h) Lowest adjacent grade at lowest elevation of deck or stairs, including
•NIA
structural support
N feet
® feet
❑ meters
El meters
Poly,
TQ0-
N feet
® feet
❑ meters
❑ meters
d
e�
N feet
❑ meters
® feet
❑meters
rA feet
❑ meters
® feet
❑ 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 tine 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
❑ Check here if attachments. licensed land surveyor? ® Yes ❑ No
Name
Charles A. R
Land Surveyor
12606 - 82nd Ave.
Company Nama
City K
Date
OZ
License Number 29291
Summit Surveying Inc.
state ZIP Cod
WA 98034
4 / I S- 1(425) 814-8487
ls_.
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 P.O. Route and Box No. Policy Number:
7532 - 243rd PL SW
Company NAIC Number:
City State ZIP Code
Frimnnrlc 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 ® Z /Z - / I -�:—
SECTION E - BUILbAG ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE)
For Zones AO and A (without BFE), complete Items El-E5. If the Certificate is intended to support a LOMA or LOMR-F request, complete Sections A, Rand C_
For Items E1-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 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, crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
b) Top of bottom floor (including basement, crawispace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ 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 ❑ feet ❑ meters ❑ above or ❑ below the HAG.
E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or ❑ below the HAG.
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 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
Address City State ZIP Code
Signature Date Telephone
Comments
❑ 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. ❑ 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.)
G2. ❑ A community official completed Section E for a building located in Zone A (withouta 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 I 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) of the building: ❑ feet ❑ meters 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
fl Check here if attachments.
ELEVATION CERTIFICATE, page 3 BUILDING PHOTOGRAPHS
See Instructions for Item A6.
ELEVATION CERTIFICATE, page 4 BUILDING PHOTOGRAPHS
Continuation Page