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Home My WebLink AboutSWP272786 l Certificate Summary Report Date: 12/11/00 Directory: Data01 Complete Certificates Page: 2 r Owner: Plumbers and pipefitters Union Trust Address: Oakesdale ave sw @ black river Other Description: lot 4a Community Description: Type: EC Certifier's Last Name: Hagenson License#: WA PE21823 Certification Date: 8/30/1994 Owner: RiverTech, LLC-Blackriver Address: 600 SW Oakesdale Ave SW Other Description: Building D Lots 1, 2, 3 of City SP 98-074 Community Description: Blackriver Corp Park Type: EC Certifier's Last Name: Campbell License M 34135 Certification Date: 12/22/1999 Owner: Rivertech LLC-Blackriver Address: 1300 SW 7th st St Other Description: Building E; lots 1, 2, and 3 of the Renton SHPL980074 Community Description: Blackriver Corp Park Type: EC Certifier's Last Name: Campbell License#: 34135 Certification Date: 12/22/1999 Owner: Marriott International North Building Address: 9000 19th St SW Other Description: Townplace Suites, NOrth buiding Community Description: Hotel Type: NE Certifier's Last Name: Sadr License#: 24661 Certification Date: 10/23/2000 Owner: Marriott International South Building Address: 9000 19th St SW Other Description: Townplace Suites South Building Community Description: Hotel-South buiding Type: NE Certifier's Last Name: Sadr License M 24661 Certification Date: 10/23/2000 FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE Important: Read the instructions on pages 1 -7. SECTION A-PROPERTY OWNER INFORMATION AM _ r-- -- BUILDING OWNER'S NAME = � BLACKRIVER—RIVERTECH, LLC BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Z OAKSDALE AVENUE SW STATE ZIP CODE CITY RENTON WA 98055-1224 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) LOT 1 OF BLACKRIVER TRACT B SHORT PLAT, KING COUNTY REC. NO. 9809109004 BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use Comments section if necessary.) NON—RESIDENTIAL - LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: ( SOURCE: W GS( yp ): RAPID STATIC #t#� '##°-# ##.#r or ## # U 1927 LJ NAD 1983 U USGS Quad Map Lj Other: 470-28'-30"/122'-14'-00" SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 01.NFIP COMMUNITY NAME&COMMUNITY NUMBER 82_COUNTY NAME 63,STATE RENTON CI KING WASHTNGTON B4.MAP AND PANEL B5.SUFF111-08-99 B6.FIRM INDEX 87.FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATiON(S) NUMBER DATE EFFECTIVE/REVISED DATE ZONE(S) (Zone AO,use depth of hooding) 530088-u97ti F 1 MAY 16 1995 1 AE x 15 B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in B9. JJ FIS Profile JXJ FIRM LJ Conxmunity Determined LJ Other(Describe):- B11. Indicate the elevation datum used for the BFE in B9:W NGVD 1929 LJ NAVD 1988 LJ Other(Describe): B12. Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? LJ Yes (f 1 No Designation Date: SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) CZBuilding elevations are based on: LJConstruction Drawings' LJBuitcfirg Under Construction' Jx JFiinished Construction 'A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 1 (Select the building diagram most similar to the building for which this certificate is being completed- see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) C3. Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,VI-V30,V(with BFE),AR,ARIA,AR/AE,AR/A1-A30,AR/AH,AR/AO Complete Items G3a-i below according to the building 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 the datum to that used for the BFE.Show field measuremer►ts and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G.as appropriate,to document the datum conversion. Datum- NAVT) R8 Comrersion/Cornments CITY OF RENTON VERTICAL CONTROL (GPS STATION 1854) Elevation reference mark used GPS STA - 1854 Does the elevation reference mark used appear on the FIRM? LJ Yes; (X J No O a)Top of bottom floor(including basement or enclosure) 17 . 7 fL(m) O b)Top of next higher floor N/A —k(m) " �- C�� O c) Bottom of lowest horizontal structural member(V zones only) N/A _fL(m) o o �Q •�'WAS�;dN ❑ d)Attached garage(top of slab) N/A ❑ e) Lowest elevation of machinery and/or equipment w W Q)�' servicing the building NIA —ft.(m) o z' O f) Lowest adjacent grade(LAG) 16. 6 fl.(m) O g) Highest adjacent grade(HAG) 16. 9 ft.(m) 3413 9.. ' ❑ h) No.of permanent openings(flood vents)within 1 It, above adjacent grade_ 0 $ j ' 07sTBR�:• , O )Total area of all permanent openings(flood vents)in C3h 0 sq.in.(sq.cm) S SECTION D-SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATI Delos/p t\ This certification is to be signed and sealed by a(and surveyor,engineer, or architect authorized by law to ce l certify that the information in Sections A, B, and C 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. CERTIFIER'S NAME LICENSE NUMBER BRYAN L. CAMPBELL P.L.S. 34135 TITLE PROJECT MANAGER COMPANY NAME BUSH, ROED & HITCHINGS, INC. ADDRESS 2009 MINOR AVENUE EAST CITY SEATTLE STATE WA ZIP CODE 98102 SIGNATURE DATE TELEPHONE (206) 323-4144 FEMA Form 81-31,AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance companyVto: . BUILDING STREET ADDRESS(Including Apt-,Unit,Suite,and/or Bldg. No.)OR P.O.ROUTE AND BOX NO- PoUcy Nurtber 602 OAKSDALE AVENUE SW =;• CITY STATE ZIP CODEo�ipaiiy IfA1CTtAt�if2Er RENTON WA 98055-1224 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 ELEVATION CONVERSION FOR THIS AREA IS BASED ON ELEVATION DIFFERENCES BETWEEN NGVD 29 AND NAVD 88 AS PTiBTTSHFD FOR NGS BFNClUiARK POINTS NN252 AND B-139. VERTICAL TITFFFRFNcE = 3 59 FFFT NCVD 29 ELEVATION = NAVD. 88 ELEVATION - 3.59 FEET La Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) nor Zone AO and Zone A(without BFE),complete Items E1 through E4. ff the Elevation Certificate is intended for use as supporting 7fonnation for a LOMA or LOMR-F, Section C must be completed. _1_ Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed- see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) 2.The top of the bottom floor(including basement or enclosure)of the building is I I I ft.(m)I I Gn.(cm) U above or Lj below (check one)the highest adjacent grade. 3. For Buioiing Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is I I I ft.(m)I I lin.(cm)above the highest adjacent grade. 4. For Zone AO only: If no flood depth number is available,is the top of the bottom floor elevated in accordance with the coiTxrxmity's ftoodp4ain management ordinance?Lj Yes Lj No (iI Unknown. The"official must certify this infoRnation 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 FEMA4ssued or cnununity4ssued BFE)or Zone AO must sign here. 'ROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME ADDRESS CITY STATE ZIP CODE. SIGNATURE DATE TELEPHONE :OMMENTS Lj Check here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) e local official who is authorized by law or ordinance to administer the community's tloodplain management ordinance can complete ctions A, B.C(or E),and G of this Elevation Certificate. Complete the applicable items)and sign below. Lj The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer,or architect who is authorized by state or local law to certify elevation information. (Indicate the source and hate of the elevation data in the Comments area below.) LJ A community official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zdne AO. Lj The f6)lowing information(Items G4-G9)is provided for community floodplain management purposes. 4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLIANCE/OCCUPANCY i ISSUED This permit has been issudcl-fb4- I_J New Construction " Substantial Improvement Elevation of as-built lowest ftoor'Cnctuding basement)of the building is: _ft.(m)Datum: BFE'ar(in Zone AO)depth of flooding at the buildng site is: _ft.(m)Datum: )CAL OFFICIAL'S N(.ME TITLE )MMUNITY NAME TELEPHONE 3NATURE DATE WMENTS J_J Check here if attachments LA Form 81-31,AUG 99 REPLACES ALL PREVIOUS EDITIONS FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE Important: Read the instructions on pages 1 -7. SECTION A-PROPERTY OWNER INFORMATIONr�rraremipa[}yl e� BUILDING OWNER'S NAMEr _ BLACKRIVER—RIVERTECH, LLC BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg_No.)OR P_O.ROUTE AND BOX NO_ Cryrn�ahyj�tfSTGimbelE_� 604 OAKSDALE CITY STATE ZIP CODE _ RENTON WA 98055-1224 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc_) LOT I OF BLACKRIVER TRACT B SHORT PLAT, KING COUNTY REC. NO. 9809109004 BUILDING USE(e.g_,Residential,Non residential,Addition,Accessory,eta Use Comments section if necessary.) NON—RESIDENTIAL - LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: tXj GPS(Type): RAPID STATIC ( ##f°-##'-##.##- or ##_#####*) LJ NAD 1927 W NAD 1983_ (_J USGS Quad Map U Other: 470-28'-30"/1220-14'-00" SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 131.NF1P COMMUNITY NAME&COMMUNITY NUMBER 62.COUNTY NAME 83.STATE RENTON CIT KINGWASHTNGTON B4.MAP AND PANEL 135_SUFFIX 136-FIRM INDEX B7.FIRM PANEL B8.FLOOD 1319.BASE FLOOD ELEVATION(S) NUIWER I I DATE EFFECTIVE/REViSED DATE ZONE(S) I (Zone AO,use depth of flooding) 530088-U976 F 11-08-99 MAY 16 1995 AE x 15 B10.Indicate the source of the Base Flood Elevation(BFE)data or base flood depth entered in 09. rofi LJ FIS Ple JY FIRM L1 Community Detemlined l_1 Other(Describe):- B11. Indicate the elevation datum used for the BFE in B9:W NGVD 1929 " NAVD 1988 L)Other(Describe): B12.Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? LJ Yes [X I No Designation Date; SECTION C-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) C t:Building elevations are based on: LJConstruction Drawings* "Buitdaig Under Construction* (X)Finished Construction `A new Elevation Certificate wig be required when construction of the building is complete. C2. Building Diagram Number 1 (Select the building diagram most similar to the bukfing for which this certificate is being completed- see pages 6 and 7. If no diagram accurately represents the budding,provide a sketch or photograph.) C3.. Elevations—Zones Al-A30,AE,AH,A(with BFE),VE,VI-V30,V(with BFE),AR,ARIA,AR/AE,AR/A1-A30,AR/AH,AR/AO Complete Items C3a4 below adding to the building diagram specified in Item C2.State the datum used. ff the datum is different from the datum used for the BFE in Section B,convert the datum to that used for the BFE Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G,as appropriate,to document the datum conversion. Datum NAVn 88 Conversion/Comments CITY OF RENTON VERTICAL CONTROL (GPS STATION 1854) Elevation reference mark used GPS STA — 1854 Does the elevation reference mark used appear o RM? Yes (X I No ❑ a)Top of bottom floor(including basement or enclosure) 17 4 ft.(m) ❑ b)Top of next higher floor N/A _ft.(m) N ❑ c) Bottom of lowest horizontal structural member(V zones only) N/A _ft_(m) m p �5 ' ❑ d)Attached garage(top of slab) N/A —ft.(m) E a � , O e) Lowest elevation of machinery and/or equipment w o servicing the building N/A ._ft. � (m) E;, ; � ❑ f) Lowest adjacent grade(LAG) 16. 8 ft.(m) 2 O ❑ g) Highest adjacent grade(HAG) 17. 1 ft.(m) N 34135 e?•' ❑ h) No.of permanent openings(flood vents)within 1 ft. above adjacent grade _0 8 Gr�T�R°. Q- ❑ i)Total area of all permanent openings(flood vents)in C3h 0 sq.in.(sq.cm) SECTION D-SURVEYOR,ENGINEER, OR ARCHITECT CERTIFICATI �D This certification is to be signed and sealed by a land surveyor,engineer,or architect authorized by law to certify elevation In orma certify that the information in Sections A, B, and C 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 16 U.S. Code Section 1001. CERTIFIER'S NAME LICENSE NUMBER BRYAN L. CAMPBELL P.L.S. 34135 TITLE PROJECT MANAGER COMPANY NAME BUSH, ROED & HITCHINGS, INC. ADDRESS 2009 MINOR AVENUE EAST CITY SEATTLE STATE WA ZIP CODE 98102 SIGNATURE DATE TELEPHONE _ (206) 323-4144 FEMA Form 81-31,AUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces, copy the corresponding information from Section A. For Kstxan.ce Conipan I I BUILDING STREET ADDRESS(including Apt_,Unit,Suite,and/or Bldg. No.)OR P.O.ROUTE AND BOX NO_ Pocyi/u+Yiber 604 OAKSDALE AVENUE SW CITY STATE ZIP CODE Cow IJAtC Nu�r RENTON WA 98055-1224 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)buildKhg owner. COMMENTS ELEVATION CONVERSION FOR THIS AREA IS BASED ON ELEVATION DIFFERENCES BETWEEN NGVD 29 AND NAVD 88 AS PUBLISHED FOR NCS BENCHMARK POINTS NN252 AND B-139 VERTICAL DTFFERFNCE = 3-59 FRET NGVD 29 ELEVATION = NAVD-88 ELEVATION — 3.59 FEET L1 Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) -or Zone AO and Zone A(without BFE),complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting nformation for a LOMA or LOMR-F, Section C must be completed. :1. Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed— see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) 2.The top of the bottom floor('mduding basement orerxiosure)of the building is I_ I ft.(m)i I n.(cm) U above or (J below (check one)the highest adjacent grade. :3. For Building Diagrams 6-8 with openings(see page 7),the next higher floor or elevated floor(elevation b)of the buNding is I I 1 ft.(m)( I lin.(cm)above the highest adjacent grade. :4. For Zone AO only: If no flood depth number is availlable,is the top of the bottom floor elevated in accordance withh the comiunity's floodplain management ordinance?LJ Yes (,I No L Unknown. The local offiial must certify this i ftv%a bon 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. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME 4DDRESS CITY STATE ZIP CODE. >IGNATURE DATE TELEPHONE 30MMENTS u heck here if attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) ►e total official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete ;lions A, B,C(or Q,and G of this Elevation Certificate. Comte the applicable hem(s)and sign below. 1. U The information in Section C was taken from other documentation that has been signed and embossed by a Licensed surveyor, engineer,or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) >. (_J A community official completed Section E for a building located in Zone A(without a FEMA-issued or corr>:rxuhity-issued BFE)or Zone`AO. t-LJ The following information(Items G4-G9)is provided for community floodplain management purposes. ,4.PERMIT NUMBER G5. DATE PERMIT ISSUED GG. DATE CERTIFICATE OF COMPLIAN TIOCCUPANCY rt.is ISSUED Thin$ permit has been issued for (�New Construction "Substantial Improvement Ele ion of as-built lowest floor(including basement)of the building is: _IL(m)Datum: BFE or tm Zone AO)depth of flooding at the building site is: _ft.(m)Datum: )CAL OFFICIAL'S NA E TITLE IMMUNITY NAME TELEPHONE GNATURE DATE )MMENTS J_J Check here if attachments 1A Form 81-31,AUG 99 REPLACES ALL PREVIOUS EDITIONS i i f FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 NATIONAL FLOOD INSURANCE PROGRAM Expires July 31, 2002 ELEVATION CERTIFICATE Important: Read the instructions on pages 1 -7. SECTION A-PROPERTY OWNER INFORMATION 'crsirartce BUILDING OWNER'S NAME BLACKRIVER-RIVERTECH, LLC _ BUILDING STREET ADDRESS(Including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. Con%pah`y 606 OAKSDALE AVENUE S.W. = CITY STATE ZIP CODE KENTON WA 98055-1224 PROPERTY DESCRIPTION(Lot and Block Numbers,Tax Parcel Number,Legal Description,etc.) LOT 3 OF BLACKRIVER TRACT B SHORT PLAT, KING COUNTY REC. NO. 9809109004 BUILDING USE(e.g.,Residential,Non-residential,Addition,Accessory,etc. Use Comments section if necessary.) NON-RESIDENTIAL - LATITUDE/LONGITUDE(OPTIONAL) HORIZONTAL DATUM: SOURCE: IX_I GPS(Type): RAPID STATIC ( W-##'-##.i>r or ##. 7 L__I NAD 1927 M NAD 1983 LJ USGS Quad Map 1_-_l Other. 470-28'-30"/122'-14'-00" SECTION B-FLOOD INSURANCE RATE MAP(FIRM)INFORMATION 81.NFIP COMMUNITY NAME&COMMUNITY NUMBER 82 COUNTY NAME B3_STATE RENTON CIT KING Bd.MAP AND PANEL B5.SUFFIX B6_FIRM INDEX B7.FIRM PANEL B8.FLOOD B9.BASE FLOOD ELEVATION(S) NUMBER DATE EFFECTP/EIREVISED DATE ZON (S) (Zone AO,use depth of doo 09) 530088-0976 F 11-08-99 1 MAY 16 1995 1 AE X 15 B10. Indicate the source of the Base Flood Elevation(BFE)data or base Rood depth entered in B9. LJ FIS Profile J XJ FIRM LJ Community Determined LJ Other(Describe):- 1311. Indicate the elevation datum used for the BFE in B9:LXI NGVD 1929 LJ NAVD 1988 LJ Other(Describe): B12.Is the building located in a Coastal Barrier Resources System(CBRS)area or Otherwise Protected Area(OPA)? LJ Yes VJ No Designation Date: SECTION C.-BUILDING ELEVATION INFORMATION(SURVEY REQUIRED) 31._Building elevations are based on: LJConstruction Drawings" LJBuildang Under Construction' lX JFinished Construction 'A new Elevation Certificate will be required when construction of the txiW&V is complete. C2. Building Diagram Number 1 (Select the building diagram most similar to the bung for which this certificate is being completed- see pages 6 and 7. If no diagram accurately represents the budding,provide a sketch or photograph.) C3.Elevations-Zones Al-A30,AE,AH,A(with BFE),VE,VI-V30,V(with BFE),AR,AR/A,AR/AE,AR/A1-A30,AR/AH,AR/AO Complete Items C3a-i below according 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 the datum to that used for the BFE.Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G,as appropriate,to document the datum conversion. Datum NAVP 9,q ConverskxVComments CITY OF RENTON VERTICAL CONTROL (GPS STATION 1854) Elevation reference mark used GPS STA - 1854 Does the elevation reference mark used appear o No O a)Top of bottom floor(including basement or enclosure) 17. 2 ft.(m) ❑ b)Top of next higher floor N/A —ft(m) �.*C ❑ c) Bottom of lowest horizontal structural member(V Zones only) N/A _ft.(m) o o �',•'Ow ❑ d)Attached garage(top of slab) N/A —ft.(m) E g ❑ e) Lowest elevation of machinery and/or equipment "'-o d; servicing the building N/A _ft.(m) a ❑ 0 Lowest adjacent grade(LAG) 16, 6 ft.(m) ❑ g) Highest adjacent grade(HAG) 16. 8 fl.(m) h �°rsTVRti�'• J ❑ h) No.of permanent openings(flood vents)within 1 ft. above adjacent grade- 0 $ •••••• S� �D ❑ i)Total area of all permanent openings (flood vents)in C3h 0 sq.in. (sq.cm) SAL LAB SECTION D-SURVEYOR,ENGINEER,OR ARCHITECT CERT►FICATIO ' 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 in Sections A, B,and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine orimprisonment under 18 U.S. Code Section 1001. CERTIFIER'S NAME LICENSE NUMBER BRYAN L. CAMPBELL P.L.S. 34135 TITLE PROJECT MANAGER COMPANY NAME BUSH, ROED 5 HITCHINGS, INC. ADDRESS 2009 MINOR AVENUE EAST CITY SEATTLE STATE WA ZIP CODE 98102 SIGNATURE DATE TELEPHONE (206) 323-4144 FEMA Form 81-3tAUG 99 SEE REVERSE SIDE FOR CONTINUATION REPLACES ALL PREVIOUS EDITIONS IMPORTANT: In these spaces, copy the corresponding information from Section A. For Insurance Company- BUILDING STREET ADDRESS(including Apt.,Unit,Suite,and/or Bldg.No.)OR P.O.ROUTE AND BOX NO. pb1.icy Number 606 OAKSDALE AVENUE SW CITY RENTON STATE WA ZIP CODE CornpNA1C NtirYr 98055-1224 SECTION D-SURVEYOR, ENGINEER,OR ARCHITECT CERTIFICATION(CONTINUED) Copy both sides of this Elevation Certificate for(1)community official, (2)insurance agenVcompany,and(3)building owner. COMMENTS ELEVATION CONVERSION FOR THIS AREA IS BASED ON ELEVATION DIFFERENCES BETWEEN NGVD 29 AND NAVD 88 AS PIIBTTSHFD FOR NGS BENCHMARK POINTS NN252 AND B-139. VERTICAL DTFFFRFNCE = '1 59 FEET NGVD 29 ELEVATION = NAVD..88 ELEVATION - 3.59 FEET I-1 Check here if attachments SECTION E-BUILDING ELEVATION INFORMATION(SURVEY NOT REQUIRED)FOR ZONE AO AND ZONE A(WITHOUT BFE) or Zone AO and Zone A(without BFE),complete Items E1 through E4. ff the Elevation Certificate is intended for use as supporting )formation for a LOMA or LOMR-F, Section C must be completed. A, Building Diagram Number (Select the building diagram most similar to the building for which this certificate is being completed- see pages 6 and 7. If no diagram accurately represents the building,provide a sketch or photograph.) 2.The top of the bottom floor(including basement or enclosure)of the buillding is I I 1 ft.(m)(_(_Jin.(cm) (_J above or U below (check one)the highest adjacent grade. 3. For Buik"Diagrams"with openings(see page 7),the next higher floor or elevated floor(elevation b)of the building is ( 1 I ft.(m)I I Iin.(cm)above the highest adacent grade. 4. For 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?LJ Yes LJ No IJ Unknown. The kx;al 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(with)ut a FEMA4ssued or mrnmunity-issued BFE)or Zone AO must sign here. 'ROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME JDDRESS CITY STATE ZIP CODE IGNATURE DATE TELEPHONE :OMMENTS (_J Check here if-attachments SECTION G-COMMUNITY INFORMATION(OPTIONAL) e k>caf official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete ctiions A, B,C(or E),and G of this Elevation Certificate. Complete the applicable item(s)and sign below. LJ The information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor. engineer,or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) (J A cbminunity official completed Section E for a building located in Zone A(without a FEMA-issued or community-issued BFE)or Zone AO.,. (J The following,information(Items G4-G9)is provided for community floodplain management purposes. 4. PERMIT NUMBER G5. DATE PERMIT ISSUED G6. DATE CERTIFICATE OF COMPLI,MNCE/OCCUPANCY ISSUED This permit has been issued kc (J New Construction U Substantial Improvement EleV1t; of as-built lowest floor(including basement)of the building is: _fL(m)Datum: BFE cif{itr Zone AO)depth of flooding at the building site is: _ft.(m)Datum: )CAL OFFICIAL'S'IAME TITLE )MMUNITY NAME TELEPHONE 3NATURE DATE )MMENTS Check here C.Ottachments IA Form 81-31,AUG 99 REPLACES ALL PREVIOUS EDITIONS 1 Short PIat'(SHPI:#* ) Prelim.hat (PP# REQUF�.ST FOR PR07EC't# ) CAG# To: Technical Services Date IN61,a ,�,(q'f�1 WO# � �3-P 5 Green# � � yG n7 From: Plan Review/Project Manager 4 / 6 / i t .J of v7r- c lz L L c Project Name (10 cha zac s max) Description of Project: G [J Circle Size of Waterline: 8 (10 12" Circle One: New or Extension C i'fiy t.tn e Circle Size of Sewerline: 8" 10" 12" Circle One: ( New )or Extension 2 t- r y �• Circle Size of Storrnline: 12" 1 18" 24" Circle One: New or Extension p-�- 1 As L. Address or Street Names) c) d `; <, �� a I Y� t y, `S r' Dvlpr/Contractor/Owner-Cnslt:- L P N (0 charaacrs n=) 4 Avc- Check each discipline involved in Project Ltr Drwg #of sheets per discipline ' 1 ❑ C 2. `I f% T= C4 •7 ❑ Trans-Storm h aC I-,- r�l v�� ` t rl ❑ �Z 7 (Roadway/Dainagc) (Off site i nprovcn=ts)(indudc basin name) (include TESC sheets) ❑ Transportation (Signalization,Channclization,Lighting) ❑ ❑ J ❑ ❑ C5 1 r ❑ Wastewater l L /; -•(J�Y t Sanitary Scwcr Main(ndude basin name)' / ❑ Water (Mains.Valves.Hydrants) 0 (Include composite fi Horizontal Ctr{Sheetsl ❑ Suface. Water ❑ ❑ Improvements (CLP ONLY)(includc basin name) TS Use Only � r IX � n