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IMPORTANT: In these spaces, copy the coresponding information from Section A.FOR INSURANCE COMPANY USE <br />Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P-O. Route and Box No. <br />171 HERON FARM LANE <br />Policy Number: <br />City <br />ELLENSBURG <br />State <br />Washington <br />ZIP Code <br />98926 <br />Company NAIC Number <br />sEciloN G - coMMUNtTY TNFORMATTON (OPTTONAL) <br />The local official who is authorized by law or ordinance to administer the community's floodplain management ordinance can complete <br />Sections A, B, C (or E), and G of this Elevation Certificaie. Complete the applicable item(s) and sign below. Check the measurement <br />used in ltems Grc10. ln Puerto Rico only, enter meters. <br />Gi. n The information in Section C was taken from olher documentation that has been signed and sealed by a licensed surveyor, <br />engineer, or architect who is authorized by law to certifu elevation information. (lndicate the source and date of lhe elevation <br />data in the Comments area below.) <br />G2.f] A community official completed Section E for a building located in Zone A (without a FEMA-issued or community-issued BFE) <br />or Zone AO. <br />G3. I The following information (ltems G,$-G10) is provided for community floodplain management purposes. <br />G4. Permit Number G5. Date Permit lssued G6. Date Gertificate of <br />Compliance/Occupancy lssued <br />G7. This permit has been issued for: I ttew Construction I Substantial lmprovement <br />G8. Elevation of as-built lowesi floor (including basement) <br />of the building: <br />G9. BFE or (in Zone AO) depth of flooding at lhe building site: <br />G10. Community's design flood elevetion: <br />fl feet fl meters <br />fl feet ! meters <br />I feel f] meters <br />Datum <br />Datum <br />Datum <br />Local Official's Name Title <br />Community Name Telephone <br />Signature Date <br />Comments (including type of equipment and location, per C2(e), if applicable) <br />I Check here if aftachmenls. <br />ELEVATION CERTIFICATE OMB No. 1660-0008 <br />Expiration Date: November 30, 2022 <br />FEMA Form 086-0-33 (1 2/1 9)Replaces all previous editions.Form Page 4 of6