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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, andlor Bldg. No.) or P.O. Route and Box No. <br />Policy Number. <br />3008 Dapple Gray Way <br />City State ZIP Code <br />Company NAIC Number <br />Ellensburg Washingtran 98926 <br />SECTION G —COMMUNITY INFORMATION (OPTIONAL) <br />The local official who Is authorized by law or ordinanos to administer the community's floodplaln management ordinance can complete <br />Sections A, 8, C (or E), and a of this Elevation Certificate. Complete the applicable item(s) and sign below. Check the measurement <br />used in Items G6—G10. in Puerto Rico only, enter meters. <br />G1. ❑ The information 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 certify elevation information. (Indicate the source and date of the elevation <br />data In the Comments area below.) <br />G2 ❑ A community oicial completed Section E for a building located In Zone A (without a FEMA-Issued or community -issued BFE) <br />or Zone AO. <br />G3. ❑ The following information (Items 134-G10) is provided for community iloodplain management purposes. <br />G4. Permit Number <br />G5. Dane Permit Issued <br />06, Data Certificate of <br />Compliance/Occupancy Issued <br />07. This permit has been Issued for: x❑ New Constriction ❑ Substantlal Improvement <br />08. Elevation of as -built lowest floor (including basement) <br />of the building: []feet ❑ meters Daturn <br />139. BFE or (in Zone AO) depth of flooding at the building site: ❑ feet ❑ meters Datum <br />G10. Community's design flood elevaton: ____ ❑ feet ❑ meters datum <br />Local Official's Name Title <br />Community Name Telephone <br />Signature Data <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 />