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ELEVATION CERTIFICATE <br />OMB No.1660-0008 <br />Expiration Date: November 30, 2022 <br />IMPORTANT: In there spaces, copy the corresponding Information from Section A. <br />FOR INSURANCE COMPANY USE <br />Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. <br />Polley Number. <br />2915 Roan Drive <br />City State ZIP Code <br />Company NAIC Number <br />Ellensburg Washington 98926 <br />SECTION E -- BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) <br />FOR ZONE AO AND ZONE A (WITHOUT BFE) <br />For Zones AO and A (without BFE} complete Items E1--E6. If the Certificate Is intended to support a LOMA or LOMR-F request, <br />complete Sections A, Band C. For Items E'I--£4, use natural grade, if available. Check the measurement used. In Puerto Rico only, <br />enter meters. <br />E1. 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) Top of bottom floor (including basement, <br />crawlspace, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the HAG. <br />b) Top of bottom floor (including basement, <br />orawlspece, or enclosure) is ❑ feet ❑ meters ❑ above or ❑ below the LAG. <br />E2. For Building Diagrams " 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 ❑ below the HAG. <br />E3. Attached garage (top of slab) is ❑ feet ❑ meters ❑ above or []below the HAG. <br />E4. Top of platform of machinery and/or equipinent <br />servicing the building is ❑ feat ❑ meters ❑ above or ❑ below the HAG. <br />E5. Zone AO only: If no ttood depth number Is available, Is the top of the bottom floor elevated in accordance with the communWe <br />floodplain management ordinance? ❑ Yes ❑ No ❑ Unknown. The lord official must certify this Information in Section G. <br />SECTION F -- PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION <br />The property owner or owner's authorized representative who completes Sections A, 8, and E for Zone A (without a FEMA-Issued or <br />community -issued BFE) or Zone AO must sign here. The statements In Sections A, B, and E are correct to the best of my knowledge. <br />Property Owner or Owner's Authorized Representative's Name <br />Scott Benson <br />Address City state ZIP Code <br />1224 8 Pioneer Way Moses Lake Washington 98837 <br />Signature Date Telephone <br />(509) 86"112 <br />Comments <br />❑ Check here if attachments. <br />FEMA Form 086-0-33 (12119) Replaces all previous editions. Form Page 3 Of 43 <br />