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ELEVATION CERTIFICATE <br />OMS No.1660.0008 <br />Explrallon Date: November 30, 2022 <br />IMPORTANT: In these spaces, copy the corresponding Intornutton from Sectlon A. <br />FOR INSURANCE COMPANY USE <br />BWlding Street Address (including Apt., Unit, Suite, andtor Bldg. No.) or P.O. Route and Box No. <br />Policy Number: <br />3010 Dapple Gray Way <br />CRY State ZIP Code <br />CompwW NAIL 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 floodplain management ordinance can complete <br />Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable items) and sign below. Check the measurement <br />used In Items 08-G10. In Puerto Rico only, enter motors. <br />a1. ❑ 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 />Q2. © A community official completed Section E for a building located In Zone A (without a FEMA-Issued or community-lssued BFE) <br />or Zone AO. <br />G3. ❑ The following information (Items G4-G1O) Is provided for community floodplain management purposes. <br />G4. Permit Number <br />G5. Date Permit Issued <br />06. Date Certificate of <br />ComplianoelOccupancy Issued <br />G7. This permit has been Issued for. ❑x New Construction ❑ Substantial Improvement <br />G& Elevation of as -built lowest floor (including basement) <br />of the building: ❑ feet ❑ meters Datum <br />G9. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ metma Datum <br />G10. Community's design flood elevation: ❑ feet ❑ meters Datum <br />Local Official's Name Tltie <br />Community Name Telephone <br />Signature Date <br />Comments (including type of equipment and location, per C2(e). if applicable) <br />❑ Check here if attachments. <br />FEMA Form 086-0-33 (12119) Replaces all previous editions. Form Page 4 of 6 <br />