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IMPORTANT: ln lheso spacos, copy lhe correspondlng lnforrnatlon from Secllon A.FOR INSURANCE COMPANY USE <br />Building Slreol Address (including Apl., Unit, Sulte, and/or Bldg. No.) or P.O. Route ancl Box No. <br />3005 Dapple Gray Way <br />Policy Number: <br />Cily State <br />Washington <br />ZIP Code <br />s8926Ellensburg <br />Company NAIC Numbsr <br />sEcTloN E - BU|LD|NG ELEVATTON INFORMATTON (SURVEY NOT REQUTRED) <br />FOR ZONE AO AND ZONE A (W|THOUT BFE) <br />For Zonos AO and A (without BFE), complete llems E1-E5. lf lhe Certilicato is intended to support a LOMA or LOMR-F request, <br />complele Sections A, B,and C. For ltems E1-E4, use nalural grade, if avallable. Check the measurement used. hr Puerlo Rico only, <br />enter melers, <br />E1. Provide elovalion information for lhe following and check lhe appropriate boxes lo show whelher the elovalion ls above or below <br />tho highesl adJacenl grade (HAG) and lhe lowest adjacenl grade (LAG). <br />a) Top of boltom floor {including basemenl, <br />crawlspaco, or onclosure) is <br />b) Top of bollom lloor {including basemenl, <br />crawlspace, or enclosuro) ls <br />ff feot fl meters ! above or ff below lhe HAG, <br />I feei I melers I above or n below the LAG. <br />E2. For Building Diagrams 6-9 wilh permanent <br />the nexl higher floor (elevation C2.b ln <br />lhe diagrams) of the building is <br />flood openings provided in Seclion A llems B and/or I (see pages 1-2 of lnslructions), <br />E3. Attached garage (lop of slab) Is <br />E4. Top of plalform of machlnery and/or equipment <br />ssrvlclng the bullding ls <br />!feet Imeters <br />Efeol [meters <br />Dfeel flmoters <br />I above or flbebw the HAG. <br />I above or Ibelow the HAG. <br />I above or nbebw lhe HAG. <br />E5. Zone AO only: lf no flood deplh number ls available, is lhe top of the bollom floor elevated in accordance wilh lhe community's <br />lloodplaln management ordlnance? [ Ves I No ! Unknown. The local official musl cerlify ihis inforrnation in Section G. <br />sEcTtoN F - PROPERTY OWNER (OR OWNER'S REPRESENTATTVE) CERTIF|CAT|ON <br />The properly owner or owner's aulhorizod reprosenlalivo who complelos Seclions A, B, and E for Zone A (without a FEMA-issued or <br />community-issued BFE) or Zone AO must sign here. The slalemenls in Sections A, B, and E are correct lri lho besl of my knowledge. <br />Properly Owner or Owne/s Aulhorized Represenlative's Name <br />Scoll Henson <br />Address <br />'12245, PloneerWay <br />Clty <br />Moses Lake <br />State <br />Washington <br />ZIP Code <br />98837 <br />t Date <br />6/Q />t>a <br />Telephone <br />(509) 765.1023 <br />Comments <br />I CnecX here if allachments. <br />ELEVATION CERTIFICATE OMB No, 1660-0008 <br />Explrallon Date: Novombsr 30,2022 <br />FEMA Form 086-0-33 (12119)Roplaces all previous edilions.Form Page 3 ot 6