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ELEVATION CERTIFICATE <br />OMB No.1660-0008 <br />Expiration Data: November 30, 2022 <br />IMPORTANT: In these 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 />Policy Number: <br />2915 Roan Drive <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 fioodplaln management ordinance can complete <br />Sections A. B. C (or E), and G of this Elevation Certificate. Complete the applicable Item(s) and sign below. Check the measurement <br />used in Items G8-010. In Puerto Rico only, enter meters. <br />G1. ❑ The informatlon in Section C was taken from other documentation that has been signed and sealed by a licensed surveyor, <br />engineer, or architect who Is authorized by law to cwfify 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 FEMA4asued or community -Issued WE) <br />or Zone AO. <br />Gg, ❑ The following information (Items G4—GI0) Is provided for community floodplain management purposes. <br />04. Permit Number <br />05, Date Permit Issued <br />G6. Date Certfcate of <br />Complianoe/Oocupancy Issued <br />G7. This permit has been Issued for: New Construction ❑ Substantial Improvement <br />G8. Elevation of as -built lowest floor (including basement) 0feet ❑meters Datum <br />of the building; <br />G9. SFE or (in Zone AO) depth of flooding at the building site: ❑ feat ❑ meters Dim <br />G10. Community's design hood elevation: feet 0 meters Datum <br />Local Officials Name Title <br />Community Name Telephone <br />signature Date <br />Comments (Including type of equipment and location, per C2(e), p applicable) <br />❑ Check here if attachments. <br />FEMA Form 086-0 33 (12119) Replaces all previous editions. rorm rage +r of v <br />