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ELEVATION CERTIFICATE OMB No.1660-0008 Expiration Date: November 30, 2022 IMPORTANT: In these spaces, copy the corresponding information from Seedon A. FOR INSURANCE COMPANY USE Building Street Address (Including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. Polioy Number: 2911 Roan Drive City State ZIP Code Company NAIC Number Ellensburg Washington 96926 SECTION G — COMMUNITY INFORMATION (OPTIONAL) The local official who Is authorized by law or ordinance to administer the community's tloodplain management ordinance can complete Sections A, B, C (or E), and O of this Elevation Certificate. Complete the applicable Item(s) and sign below. Check the measurement used in Items G8—G10. In Puerto Rico only, enter meters. 01. ❑ The infommatiort in Section C was taken from other documentation that has been signed and seated by a licensed surveyor, engineer, or architect who is authorized by law to certify elevation Information. (Indicate 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 FEMA4ssued or community -Issued BFE) or Zone AO. (33. ❑ The following Information (items 04—G10) Is provided for community floodplain management purposes. 04. Permit Number G5. Date Permit issued G6. hate Certificate of Compliance/Occupancy Issued G7. This permit has been Issued for: ❑x New Construction ❑ Substanflal Improvement G6• Elevation of as -built lowest floor (Including basement) ❑ feet ❑ meters Datum of the building: G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum 010. Community's design flood elevation: ❑ feet ❑ meters Datum Local official's Name 710e Community Name Telephone Signature bate Comments (Including type of equipment and location, per C2(e), If applicable) ❑ Check here if attachments. FEMA Farm 086-0-33 02/19) Replaces all previous editions. Farm Page 4 of 6