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IMPORTANT: ln lhese spaces, copy the correspondlng lnformallon lrom Secfion A.FOR INSURANCE COMPANY USE <br />Buildlng Street Address (includlng Apt., Unit, Sulte, and/or Bldg. No.) or P.O. Route and Box No. <br />3005 Dapple Gray Way <br />Polioy Number; <br />Cily Slate <br />Washington <br />ZIP Code <br />98926Ellensburg <br />Company NAIC Number <br />sEcTtoN G - coMMUNtTy TNFORMATTON (OPT|ONAL) <br />The local official who is autho_rized by law or ordinance lo administer the community's lloodplaln management ordlnanoe can oomplele <br />Seclions A, B, C (or E), and G of thls Elevatlon Certiflcate, Complete the applicable itom(s) and sign below. Check lhe measuremenl <br />used in ltems GB-G10. ln Puerto Rico only, enter meters. <br />Gl. f] The-informatlon in Section C was taken from otherdocumontation that has been signed and sealed by a licensed $urveyor, <br />englneer, or architect who is aulhorized by law to certifu elevatlon information. (lndicate the source and date of lhe elevation <br />data in the Comments area below.) <br />G2, D A cjrrnmunity official compleled Seclion E for a building located in Zone A (wlthout a FEMA{ssued or communily-issrred BFE) <br />or Zone AO. <br />G3. n The lollowing informalion (ltems G4-c10) ls provided for community floodplain rnanagemenl purposes. <br />G4. PermitNumber G5, Date Permit lssued G6. Date Certilicale of <br />Compfiance/Ocoupancy lssued <br />G7. Thls perrnit has been issued for; fl New conslructbn n substantial lmprovement <br />G8. Elevatlon of as-built lowest floor (including basement) <br />of lhe building: <br />G9. BFE or (in Zone AO) depth of flooding at lhe buildlng slte: <br />G'10. Community's deslgn llood elevatlon: <br />I feet ! meters Detum <br />I feet I meters Dalum <br />I feel ! meters Datum <br />Local Ofliclal's Name Tltle <br />Communily Name Telephone <br />Slgnature Date <br />Comments (including type of equipment and locallon, per C2(e), if appticable) <br />I Check here if attachmenls. <br />ELEVATION CERTIFICATE OMB No. 1660-0008 <br />Expiration Date: November 30,2022 <br />FEMA Form 086-0-33 (121'lS)Replaces all previous edltlons.Form Page 4 of 6