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ELEVATION CERTIFICATE <br />OMB No. 1660-0008 <br />Expiration Hate: November 30, 2022 <br />IMPORTANT: In these spaces, soapy the corresponding Information from Section A. <br />FOR INSURANCE COMPANY USE <br />Building Street Address (including Apt, Unit, Suite, andlor Bldg. No.) or P.O. Route and Box No. <br />Policy Number <br />390 HERON FARM LANE <br />City State ZIP Code <br />Company NAIC Number <br />ELLENSBURG Washington 98926 <br />SECTION G — COMMUNITY INFORMATION (OPTIONAL) <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 0evation Certificate. Complete the applicable Item(s) and sign below. Check the measurement <br />used in items G8--G10. In Puerto Rico only, enter meters. <br />G1, ❑ The Information in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, <br />engineer, or architact who is authorized by l2w to certify elevation information. (Indicate the source and date of the elevation <br />data in the Comments area below.) <br />G2 ❑ A community official completed Section E for a building located in Zone A (without a FEMAassued or comrrwnity-issued BFE) <br />or Zone AO. <br />G3. ❑ The following information (harms G4—G10) is provided for community floodplain management purposes. <br />G4. Permit Number G5. Date Permit Issued G6. Date Certificate of <br />Complianceiancy Issued <br />G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement <br />GB. Elevation of as -built lowest floor (inducting basement) <br />of the building: ❑ feel ❑ meters Datum <br />G8. BFE or (in Zone AO) depth of flooding at the building site: _ ❑ feet ❑ meters Datu m <br />G10. Community's design flood elevation: _ ❑ feet ❑ meters Dim <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 />❑ Check here if attachments. <br />FEMA Form 086-0-33 (12119) Replaces all previous editions. Form Page 4 of 6 <br />