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ELEVATION CERTIFICATE <br />OMB No. 1660-0008 <br />Expiraiian Date: 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, andlor Bldg. No.) or P.O. Route and Box No. <br />Policy Number. <br />3012 Dapple Gray Way <br />City Slate ZIP Code <br />Company NAIL 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—E5. If the Certificate is Intended to support a LOMA or LOMR-F request, <br />complete Sections A, Bend C. For Items E1—E4, 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 />crawispace, or enclosure) Is ❑ feet ❑ meters ❑ above or ❑ below the LAG. <br />E2. For Building Diagrams 6-9 with permanent Rood openings provided in Section A Items 8 andlor 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 andlor equipment <br />servicing the building is ❑ feet ❑ meters ❑ above or ❑ below the HAG. <br />E6. Zone AO only: If no flood depth number is available, is the top of the bottom floor elevated In accordance with the community's <br />floodplain management ordinance? ❑ Yes ❑ No ❑ unknown. The local 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, B, 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 Henson <br />Address City State ZIP Code <br />1224 S Pioneer Way Moses Lake Washington 98837 <br />Signature Date Telephone <br />r . r (509) 855-5112 <br />Comments <br />❑ Check here if attachments. <br />FEMA Form 086-0-33 (12/19) Replaces all previous editions. Form Page 3 of 6 <br />