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ELEVATION CERTIFICATE <br />OMB No. 1660.0008 <br />Exoiration Date. November 30_ 2022 <br />IMPORTANT: In these spaces, copy the corresponding information from Section A. <br />FOR INSURANCE COMPANY USE <br />Building Street Address (Including Apt., Unit, Suite, andfor Bldg. No.) or P.O. Route and Box No. <br />Policy Number-- <br />umber_3124 <br />3124MCMANAMY RD. <br />C* State ZiP Code <br />Company MAIC Number <br />ELLENSBURG Washington 98926 <br />SECTION E M BUILDING ENATION INFORMATION (SURVEY KOT REQUIRED) <br />FOR ZONE AO AND PONE A ('WITHOUT BFE) <br />For Zones AO and A (without BFE), complete Hams E7—ES. If the Certificate is intended to support a LOMA or LOMR-F request, <br />compk4e Sections A, Qand C. For Items EI—E4, use natural grade, if available. Check the measurement used. In Puerto Rico only, <br />enter mefars. <br />E7. Provide elevation information for the following and check the appropriate boxes to show whether the elevation is above or below <br />the highest adjacent grade (HAG) and the lowest adjacent grade (LAG). <br />a) Tap of bottom floor (including basement, <br />crawlapace, or enclosure) is El Met ❑ meters ❑ above or ❑ below the HAG. <br />b) Top of bottom floor (including basement, <br />crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. <br />E2. For Building Diagrams 6-9 with permanent flood openings provided in Section A Items 8 and/or 9 (see pages 1-2 of Instructions), <br />the next higher floor (elevation C2.b in <br />the diagrams) of the building is ❑ feet ❑ meters ❑ above or El below the HAG. <br />E3. Attached garage (top of stab) is ❑ feet ❑ meters ❑ above or ❑below the HAG. <br />E4. 'Top of platform of machinery and/or equipment <br />servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. <br />ES. Zone AO only, If no flood depth number is available, Is the top of the bottom floor elevated in accordance with the community's <br />floodplain management ordinance? E) Yes [] No ❑ Unknown. The local official must certify this information in Section G. <br />SIEC170N F -• PROPERTY OWNER (OR OWNER'S REPREGENTATrM CMmIrIcAT1ON <br />The property owner or owner's authorized representative who completes Sections A, B, and E for Zone A (without a FEMA -issued or <br />communi4s5ued BFE) or Zone AO must sign here. The statements in Sections A, B, and E are correct to the hest of my knowledge. <br />Property Owner or Owner's Authorized Representative's Name <br />Address City state ZIP Code <br />Signature Date Telephone <br />Comments <br />❑ Check here if attachments. <br />FEMA Form 086-0-33 (12119) Replaces all previous editions. Form Page 3 of 6 <br />