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ELEVATION CERTIFICATE <br />OMB No. 166M008 <br />Expiration Dale: 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, Sulte, and/or Bldg. No.) or P.O. Route and Box No. <br />Policy Number: <br />2919 Roan Drive <br />City State ZIP Coda <br />Company NAIL Number <br />Ellensburg Washington 98926 <br />SECTION 0 — 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,13, C (or E), and G of this Elevation CwWlcate. Complete the applicable item(s) and sign below. Check the measurement <br />used in Items G"I0. In Puerto Rico only, enter meters. <br />G1. ❑ The Information In Section C was taken from other documentation that has been signed and seated by a licensed surveyor, <br />engineer, or architect who is authorized by law to certify elevation Information. (Indicate the source and date of the elevation <br />data in the Comments area below.) <br />(32. ❑ A community official completed Section E for a building located in Zone A (without a FEMA-Issue/ or community -Issued SFE) <br />or Zone AO. <br />G3. ❑ The following information (Items Gil—G10) Is provided for community hoodplain management purposes. <br />G4. Permit Number 05. Date Permit Issued 06. Date Certificate of <br />Compliance/Occupancy Issued <br />07. This permit has been issued for: 0 New Construction ❑ Substantial Improvement <br />G8. Elevation of as -built kmmst floor (Including basement) <br />of the building: ❑ feet ❑ meters Datum <br />G9. OFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum <br />010. Community's design flood elevation: ❑ feet ❑ meters Datum <br />Local Ofidel's Name Title <br />Community Name Telephone <br />Signature Date <br />Commerb (Including type of equipment and location, per C2(e), If applicable) <br />❑ Check here if attachments. <br />FEMA Form 08"-33 (12119) Replaces all previous editions. Form Page 4 of 6 <br />