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ELEVATION CERTIFICATE <br />IMPORTANT: MUST FOLLOW THE INSTRUCTTONS ON pAcEs 9-19 <br />Bullding streol Addross (lncludlng Apl., unlt, tiulte, and/or Bldg. No.) or p,o. Route and tsox No.: <br />3007 Roan Dr. <br />FOR INSURANCE COII,IPANY USE <br />City;Ellensbu Slato: WA ZIP Code; 98926 <br />Policy Number: ._='=_--* <br />Company NAIG Number: <br />'FORIZONE zoN <br />For Zones AO,Att/ o,snd A {wlthout BFE ),complote llems E 1*E5.For Items E -E4,us6 nalural grade,r avallable.il ths Certificats l9lntondedlosupportaLellerofMapChangor€qu€sl,complete Sections A,B,and c.Ghock lh€measuremont ueed.In Puerlo Rico only,onlor melers. <br />Buildlng measuroment$ ale baued on: I construcllon Drawlngs* fl outHlnp Under Conslruclon. I Finlshed Conslrucllon <br />'A new Elevatlon Certlflcale wlll be requlred when conslructlon of lhe bulldlng ls complolo <br />E"l. Frovlde rneasuremenls (C,2.a ln apptlcable Bulldlng Dlagram) for lhe tollowing and check lhe appropriate boxee lo show whether lhomeesurement ls above or balow the nalural HAG anct lhs LAG. <br />a) Top of bollom floor (including basement, <br />crawlspace, or enclosure) ls: <br />b) Top ol bollom lloor (lncluding basemeni, <br />lf feel I metors I above or l] below tbe HAG. <br />crawlspaoe, or enclosure) ls: fl leet I molers I above or I below lhe LAG. <br />E2. For Building Dlagrams 6-9 with permanenl llood oponings provlded ln Seclion A ltems I snd/or g (seo pagos 1-2 of lnstrucllons), thenext highor floor (C?,b ln appllcabloBuildingDiagramloflhebulldlngls: [] feet I melors I aboveor fl belowtheHAG. <br />E3. Atlached garage (top ot stab) ls: <br />E4, Top ol plntform of machinory and/or oqulpment <br />servlclng lhe bullding ls: <br />I foet l._l melers I aboveor [J betowthoHAG. <br />fl leet fl meters I abovo or I below the HAG. <br />E6. Zono AO only: lf no llaod deplh number ls availabls, is tho top of lhe boltom lloor etevated ln accordanco with the communit/sfloodplalnmanag6msntordlnanco? [ Yes f] tto I Unknown Thelocal olllclal muslcertifylhisinlormailoninSocuonG <br />oR. <br />The proparly owoer or owner's aulhorlzed reprosentalive who <br />slgn here. 7ho slalornents ln Secllons A, B, and E aro correcl <br />complelos Soclions A, B, 6nd E lor Zone A (wllhoul BFE) or Zono AO musl <br />lo the besl of my htowlodgo <br />! Check here lf altachmonls and descrlbe ln the Commenls area, <br />Prop€rty Owner or Owner's Authorized Roprosonlallv€ Namfi Scott Henson <br />Address: 1224 S, Pionoer Way <br />Clty: Moses Lako Slato; WA ZIP Code: 98837 <br />Slgnalure;*!*-A*-r)ta, ^.t+t Dale:ft i-'t <br />Telephono: (509) 765-1023 Exl.:Email: <br />Cornmenls: <br />FEMA Fonn FF-206-FY-22"152 {fomerly 086.0"33} tl0/22)Pago 4 of 19