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Capy bdh sdes dIb Ebvadm CeNFcale br (1) oamKnlll'oRael, (2) kw+aKe epentlaonpem/, aid (31 d#9 w�+nr• <br />NOTE: Tenporay Berrh Merk EsfaEisled near si� P�b 2001, based an Eleva6on Rek�nce Alatc RM 157. Th's RM 157 was <br />��ee a,� � 2�e ae�� n �oo�. <br />No�:wrs�dae�maeoorro�n�ad�. rat�:r�ada�yrwm�pe�ebaaie. <br />...r'S�li <br />ATIONlIFORNIATION (SURVEY NOT REQUIRED) FORZONE AOANDZONEA � <br />ForlmeAOadZareA(NitliaABFEl�cortdelelle�EltlrouphE4. MlheElaveionCeNfcabbinlendedbrusassuypoNgi�bnnafonbraL0AA4aL0ARf, <br />Sec6m C mel be oa�pleled. <br />E1.Bui3gDiegrsnNuMer_(Seiedlhebuidigdiagramrtostsimiarblhedifigbrxl�Chfiboeitifcaleabek9aa�pbled-eeapegesBand7. Mno6egramaaualdy <br />iePresenb Ihe didn9, Pmuide a sYelch orPhdo9�ap1�.) <br />E2ThebpdtiebotlomAoa(rdd�gbmamentaendo��e)dlhebuidi9is _A.(m)_haan)❑abrneor ❑bebw(chedcanellheH¢�stad�nt9iade• lUse <br />naWd giade� 1 evaie6b). <br />E3.Fa&idn8����l�PeBe�,IhenextligherAooraelevaledAoor(eleraEonb)dlhehiidrg's _A.(m)_h(an)abovetliehighestadjaoent <br />Pade. Ca�pbbkrtcC3hendqJmfmnidbrm. <br />E4.ForZmaAOmy: MroAooddephnxnberisaoalehle�Bthebpofthebdlanlborelevaledlna000iJaaewilhlheaam►r�sAoodplainmenagenenloidrarce7 <br />❑ Yes ❑ No ❑ Udaa�xi. The bcal oR�Ial mislcerEy Ihts Hortration in Section G. <br />The piopeityowerao�'s aAhaaed Rpesenta6ae who oonpleles Sec6msA B, C(Ilerts C3.h and C31 aYY), arM E brZone A(NiQaiA e FEM4issued orcarrrnuqy <br />ksuedBFE�aZoreAOmustsignheie. The�ak�lsinSectiois0.8�C�sdEaeoeireqbthabeslofmyluiwAedge. . <br />PROPERiY ONTER'S OR ONMER'S AUTHORIZED REPRESEMATNE'S NAME <br />FSchaN He�rgs <br />ADORESS CfiY STATE ZP�DE <br />15030Fighwey99 Lynmood WA 98.137 <br />SICiNATURE DAlE lELEPHONE <br />425742�609 <br />COMHENTS <br />❑ Chedc Ilefe H elfedlrtlerlts <br />SECTION 0-COR'.'AUNRY MFORMATION (OPTIONAL) <br />The bcal ofidal xho's eufqr¢ed by lawaad'mace b admirislertha oamKiril�+s Iloodplan managemeM admaioe can aortplele SecOaa 0. B, C(a�� and G dtlis EbvaBon <br />Certifr.ale. Canplele Ihe appicaLie i0em(s) erd sgn 6ebw. <br />G1. ❑ The irdama6ai in Sec4on Cvas taken frmi dherdocui�eNation tlat I�as been signed and embossed by a iwnsed wneyvr� e�giear, aaiclrled who's au0qr¢ed by <br />sUie a bcal law b ce�tiry elavaoon inroma0on. pndicale n�e sa,os a�,d daoe ota�e ekvatiai daw in u�e c«rmerAs aiea eeaw.) <br />G2. ❑ Acomnmiyol6dal aonpleled Section E fa a buldxy bcaled h Zore A(witloul a FEM4-'swed acartmmiryissued BFE) aZore A0. <br />c3. O n�e fu�v�ng:�anaEon (It�ra ca-c9) is poviaed rammruniry nooaplain marwgerrien� purposes. <br />G7. Tlrs pertnil ha been issued br. �] New Caish�cGon LJ ��� �� <br />G8. Ekva6on of as-buil b�e,st Ibor (ududing basemenq ot the buldig k: _. _A (m) oan,m _ <br />G9.BFEa(�nlnreAO)deptlioffbodingatthe6uldrgsiba: _—fl(m) DaAmi'— <br />LOCAI.OFFICIAI.'S W�IutE TITLE <br />COMMUNRY WrME TELEPHONE <br />�L:iL <br />❑ Chedc here H altachments <br />Fortn 87•31, JUL 00 REPUCES All PREVIOUS EDITIOy$ <br />`� <br />