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U.S. DEPARTMENT OF HOMELAND SECURITY OMB No. 1660-0008 <br />Federal Emergency Management Agency Expiration Date: November 30, 2022 <br />National Flood Insurance Program <br />ELEVATION CERTIFICATE <br />Important: Follow the instructions on pages 1-9. <br />Copy all pages of this Elevation Certificate and all attachments for (1) community offlciall, (2) Insurance agenUcompany, and (3) building owner. <br />SECTION A — PROPERTY INFORMATION <br />FOR INSURANCE COMPANY USE <br />Al. Building Owner's Name <br />Policy Number: <br />SSHI I.I.C. <br />A2. Building Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and <br />Company NAIL Number: <br />Box No. <br />3012 Dapple Gray Way <br />City State ZIP Code <br />Ellensburg Washington 98926 <br />A3. Property Description (Lot and Block Numbers, Tax Parcel Number, Legal Dawiplion, etc.) <br />Division 6 Lot 5, 961890 <br />A4. Building Use (e.g., Residential, Non -Residential, Addition, Accessory, etc.) Residential <br />AS. LatitudelLongituds: Let. N47°01'33.23464" Long. W120"34'34.5883" Horizontal Datum: ❑ NAD 1927 x❑ 14AD 1983 <br />AB. Attach at least 2 photographs of the building If the Carliflcate Is being used to obtain flood Insurance. <br />A7. Building Diagram Number 1 B <br />A8. For a building with a crawlspaoe or enclosure(s): <br />a) Square footage of crawispece or endosure(s) WA sq ft <br />b) Number of permanent flood openings In the crawlspace or enclosure(s) within 1.0 loot above adjacent grade <br />c) Total net area of flood openings In A8.b NIA sq in <br />d) Engineered flood openings' ❑ Yes [j] No <br />A9. For a building with an attached garage: <br />a) Square footage of attached garage 620.0D aq It <br />b) Number of permanent flood openings in the attached garage within 1.0 toot above adjacent grade 0 <br />c) Total net area of flood openings in A9.b 0.00 sq in <br />d) Engineered flood openings? ❑ Yes ❑x No <br />SECTION B — FLOOD INSURANCE RATE MAP (FIRM) INFORMATION <br />B1. NFIP Community Name & Community Number <br />82. County Name <br />B3. State <br />KITTITAS COUNTY; 630OD95 <br />KITTITAS <br />Washington <br />134. Map/Panel <br />B5. Suffix <br />86. FIRM Index <br />B7. FIRM Panel <br />88. Flood <br />B9. Base Flood Elevation(s) <br />Number <br />Date <br />Effective/ <br />Zone(s) <br />(Zone AO, use Base Flood Depth) <br />Revised Date <br />53037CID64 <br />D <br />09-242021 <br />09-24 2021 <br />AE <br />1597.0 it <br />1310. indicate the source of the Base Flood Elevation (BFE) data or base flood depth entered in Item 89, <br />❑x FIS Profile ❑ FIRM ❑ Community Determined ❑ Other/Source: <br />B11. Indicate elevation datum used for BFE in item 89: ❑ NGV01029 x❑ NAVD 1988 ❑ Other/Source: <br />B12. Is the building located In a Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)7 ❑ Yes Q No <br />Designation Date: CBRS ❑ OPA <br />FEMA Form D86-0-33 (12/19) Replaces all previous editions. Form Page 1 of 6 <br />