Res-2021-160 - Laserfiche WebLink

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IMPORTANT: ln these spaces, copy the corrosponding information from Section A,FOR INSURANCE COMPANY IjSE Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. 490 HERON FARM LANE Policy Number: City ELLENSBURG Siate ZIP Code 9E926Washington Company NAIC Number sEcTloN G - coMnuNrTY rNFoRf,iATtoN (oPTtoNAL) The local official who is authorized by law or ordinance io administer the community's floodplain management ordinance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Compleie the applicable item(s) and sign below. Check the measurement used in ltems G8-G10. ln Puerto Rico only, enter meters. G1. I The information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, engineer, or architect who is authorized by law lo certify elevetion information. (lndicate the source and date of the elevation data in the Comments area below,) G2.! A community official completed Section E for a building located in Zone A (without a FEMA-issued or communily-issued BFE) or Zone AO. I The following information (ltems G4-G10) is provided for community floodplain management purposes.G3. G4. Permit Number G5. Date Permit lssued G6. Date Certilicate of Compliance/Occupancy lssued G7. This permit has been issued for: ! l.tew Construction fl Substantial lmprovement G8. Elevation of as-built lowest floor (including basement) of the building: G9. BFE or (in Zone AO) depth of flooding at lhe building site: G10. Community's design flood elevation; I feet I meters fl feet I meters ! feet I meters Datum Datum Datum Local Official's Name Title Community Name Telephone Signature Date Comments (including type of equipment and location, per C2(e), if applicable) ! Check here if attachments. ELEVATION CERTIFICATE OMB No. 1660-0008 Expiration Date: Novembet 30, 2022 FEMA Form 086-0-33 (12l19)Replaces all previous editions.Form Page 4 of 6