23823 74TH AVE W - ELEVATION CERTIFICATE - UNDER CONSTa
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FEDERAL EMERGENCY MANAGEMENT AGENCY
NATIONAL FLOOD INSURANCE PROGRAM
ELEVATION CERTIFICATE
Read the in*uc dons on paste 1. 7.
O.M.B. No. 3067-0077
Expires July 31, 2002
SECTION A- PROPERTY OWNER INFORMATION Iz:FaliiaarioC6►iipariy(lse'`.`?.::;
ROY GORUD
BUILDING S.:TIREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Compahy NAIL Nurnber.
�.23823 - 74T'Fi�AVENUE VV � ,,,�
—CITY
EDMONDS WA Z � 1 _
PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Desaip w, etc.) M G�. g" I LOT 2, BLOCK 7, LAKE BALLINGER LAND COMPANYS PLAT SUBDIVISION No.1, VOL. 9, P. 57 & 58, tf Ie
USE (e.g., Residential, Non-residential, Addition, Away, etc. Use a Comments area, I necessary.)
�i�13� 11I�1
LATrrupmONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type):
( #f - ##- ##.#IX or ##.nit# ® NAD 1927 ❑ NAD 1983 ® USGS Quad Map ❑ Other:
47-4700.00" / 122-1951.00"
SECTIONS - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION
B1. NFIP COMMUNITY NAME & COMMUNITY NUMBER B2. CDUNTY NAME I STATE
EDMONDS, WA 530163 SNOHOMSH WA I
84. MAP AND PANEL
B5. SUFFD(
87. FIRM PANEL
B9. BASE FLOOD ELEVATION(S)
NUMBER
B6. FIRM INDEX DATE
EFFECTNEAEVISED DATE
88. ROOD ZONE(S)
(Zara AO, uee depth of1Do*d
530163 0005
D
8&78
2-19-78
A &C
280.0
B10. Indio the source of the Base Flood Elevation (BFE) data or base flood depth entered in B9.
❑ FIS PONS ❑ FIRM ® Community Detenmined ❑ Other (Descrbe):
B11. Indicate the elevation datum used for the BFE in 69: ® NGVD 1929 ❑ NAVD 19M ❑ 01her (Desorbe):
812 Is the bulling boated in a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ®No Desgnafion Date
SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED)
C1. Bulding elevations are based on: ❑ Construction Drawings" ® Buldhg UnderConstruclion' ❑ Finished Construction
'A row Elevation Certificate will be required when own of the bulding is completa
C2 Building Diagram Number I (Select the building diagram most simlar to the bolding forwhich this certificate is be completed - see pages 6 and 7. If no diagram
accurately represents to building, provide a sketch or photograph.)
C3. Elevations - Zones AlAX, AE, AH, A (with 8FE), VE, V1 30, V (with BFE), AR, ARIA, AR/AE, AR/AI AM, AR/AH, ARIAO
Complete Items C3.-a4 below aoaordhg to the budding diagram specified in Item C2 State the datum used. If the datum is different from the datum used for the BFE in
Section B, convert to datum b that used forte BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of
Section D or Section G, as appropriate, b document the datum conversion.
Dahrm NGVD 29 ConversbNComments SEE SECTION D
Elevation reference mark used Does the elevation reference mark used appearon the FIRM? ❑ Yes ® No 8 L.c1. F1._
❑ a) Top of bottom floor (including basement or enclosure) 289. 4t(m)
❑ b) Top of next higherfloor 287.5 LN
CI c) Bolbm of lowest horizontal structural member (V zones only) NA. _ft(m) p
❑ d) Attached garage (top of slab) NIA. _ft(m)
❑ e) Lowest elevation of machinery ardlor equipment
swvi*g the building (Describe in a Comments area) WA.. ft(m) E „
❑ 0 WNBst adjacent (finished) grade (LAG) 289.4 ft(m)
❑ g) Highest adjacent (fi nishad) grade (HAG) 296. 9 ft(m)
❑ h) No. of permanent openings (flood vents) within 1 ft above adjacent grade 0
❑ i) Total area of all permanent openings (flood vents) in C3.h Qsq. in. (sq. an)
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.
1 certify that the information in Sections A, B, and C on this certificate represents my best efforts to interpret the data available.
1 understand that any false statement may be punishable by fine or imprisonment under 18 U.S. Code, Section 1001.
CERTIFER'S NAME DIN MOEHRKE LICENSE NUMBER 28409
TITLE LAND SURVEYOR COMPANY NAME Ammeld, Baden & Assoc, Ine
ADDRESS CITY STATE ZIPCODE
SIGNATIM �� DATE G'�O TELEPHONE
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' AMFORTANT: In these spaces, copy the corresponding information from Section A Farin�eanoe Coriperiy Use
BUILDING DING STREET ADDRESS (Irmolrrdmg Apt, UM, Stub, eMbr Bldg. No.) OR P.O. ROUTE AND BOX NO. Patioji Ntsnber
23823 - 74TH AVENUE W.
�Y STATE ZIP CODE Carr NAiC Mlmiber
EDMONDS WA 980268510
SECTION D -SURVEYOR, ENGINEER, OR ARCHITECT CERTiFICATION (CONTINUED)
Copy both sides of this Elevation Cerfccate for (1) oommuni y of ial, (2) Insuraw agenticompany, and (3) building owner.
COMMENTS
BENCH MARK: USCGS MONUMENT'047", FOUND BRASS DISK SET IN FOUNDATION OF BUILDING No. 23423 HIGHWAY 99.
ELEVATION =404.36
SEE ATTACHED SiTE PLAN
FLOOD ELEVATION PER CiTY OF EDMONDS BUILDING DEPARTMENT.100 YEAR EVENT ELEVATION = 280.0, HIGHEST OBSERVED EVENT = 2W
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SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQU RED) FOR ZONE AO AND ZONE A "MUT ME)
For Zone AO aid Zone A (w InA BFE), complete Items E1 through E4. If the Elevation Certiicate is intended for use as supporting i nthrmation for a LOAM or LOMR-F,
Section C must be corpleted. -
E1. Building Diagram Number 1(Select the building diagram most similar to the building forwhich this certificate is being completed — see pages 6 and 7. If ro diagram aocurat ly
represents the building, provide a sketch orphotograph.)
E2. The top of the bottom floor (including bawnentor enclosure) of the building is 6 fL(m) 6'un.(om) ❑ above or ® below (deck one) the highest ad0oerd grade, (Use
natural grade, I avallable).
E3. For Bufdi g Diagrams 6$ with openings (see page 71 the ne)d higher floor or elevated floor (elevation b) of the building is _ fl(m) _en.(cm) above fire highest adjaoent
grade. Complete Hems C3.h and C3.1on front of form.
E4. ForZone A0 only: If no flood depth number is available, is the top of the bottom floorelevated in aocordance with the oommunkys floodplai n management odVenoe?
❑ Yes ❑ No ❑ Unknown. The local offiaai must certify this kftmaUion in Section G.
SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERi1FlCA11ON
The properly owner oramWs authorized representatlue who completes Sections A, B, C (Items C3.h and C3.1 only), and E for Zone A (wiflout a FIEMA4asued or community -
Issued BFE) or Zone AO must sign here. The statements to Sections A, B, C, and E are oorrect to fhe best of my krowledge.
PROPERTY OWNERS OR OWNERS AUTHORIZED REPRESENTATIVES NAME
ADDRESS CiTY STATE aP OODE
SIGNATURE DATE TELEPHONE
.r _-M'' M
SEC110N G - COMMUNITY INFORMATION (OPTIONAL)
The local of ial who Is authorised by law orordlmanoe b admirusterthe oommunIVs fioodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation
Certifloata Complete the applicable "a) and sign below.
G1. ❑ The information In Section C was taken from other doarmentation that has been signed and embossed by a licensed surveyor, engineer, or archiect who is authorized by
state or local law to oertify elevation irnlornation. indicate the source and date of the elavaatieon data In the Comments area below.)
G2. ❑ A oommunily oificlal completed Section E for a building located an Zone A (without a FEMA4saued or communly-issued BFE) or Zone AO.
G3. ❑ The fdiowi ng information (Items G4-G9) Is provided for community floodpla n management purposes.
G6. Elevation of as-buft lowest floor (including basement) of the buid'eg is: _. _fL(m) Dahrm:
G9. BFE or (in Zone AO) depth of flooding at the building site is:. _ _ a(m) Daimon:
Locw. oI Plclals NAME �-- r✓�iW,e f CEO IG,O%�Ei Q L�i4%
COMMUN- 61 y O1c ZZ_d ~.' TELEPHONE �02, = 7 71-% Z 20
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