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ELEVATION CERTIFICATE <br />IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON PAGES S-'19 <br />FOR INSURANCE COMPANY USEBulldlng StreetAddress (lncludlng Apt,, Unll, $ulte, and/or Bldg. No.) or P.O. Route and Box No. <br />Cily: Ellensburg state: WA 4P Gode: 98926 <br />3003 Dapple Gray Way <br />Polloy Number: <br />Comoanv NAIC Number <br />For Zones Ao, AR/AO, and A (wllhout BFE), complete ltems E1-E5. For ltems E1-E4, use nalural grade, if avallable. lf lhe Certiflcate is <br />inlended lo support a Letter of Map Change request, complete Seotlons A, B, and C. Check lhe measurement used. ln Puerto Rico only, <br />enter meters. <br />Bulldlng measuremenls are based on; I Conshuction Drawings* f] auitOing Under Conslrucl'on* [] Finished Construclion <br />*A new Elevation Gertificate will be required when construction of the building is complete. <br />E1. Provide measursmenls (C.2.a in applicable Bulldlng Diagram) for lhe following and check the appropriate boxes 1o show whelher the <br />measurement is above or below the natural HAG and lhe LAG. <br />E2. For Building Diagrams 6-0 with permanent flood openings provided in Section A ltems 8 and/or I (seo pagee 1-2 of lnstruotions), lhe <br />I feet I melers f] aboveor fl belowlheHAG, <br />E5. Zone AO only; lf no llood deplh number is available, is the top of the botlom floor elevated in acoordance with tho community's <br />lloodplain managemenl ordinance? [ Yee n No D Unknown The local ofliolal must certify thls lnformatlon in Sectlon G, <br />I feet I melers f] above or fl below the HAG, <br />a) Top of boltom floor (including basement, <br />crawlspace, or enclosure) is: <br />b) Top of bottom floor (lncluding basemenl, <br />crawlspace, or enclosure) ls:I feel I meters [aboveor I belowthelAG. <br />nexl higher floot (C2.b in applicable <br />Bullding Diagram) of the building is: <br />E3. Attached garage (top of slab) Is: <br />E4. Top of platform of machinery and/or equlpment <br />servlclng ihe bulldlng ls: <br />I feel I meters I above or f] below the HAG. <br />fl feet fl meters I above or ! below lhe HAc, <br />Ths property owner or owne/s authorized represenlalive who compleles Sections A, B, and E for Zone A (wllhout BFE) or Zone AO must <br />sign here. fhe statdrnenfs in Secfions A, B, and E ara correct to the best of my Rnowledge <br />f] Check hete if allaohments and desoribe in lhe Commenls area. <br />Clty; Moses Lake <br />Commenls; <br />Property Owner or Ownefs Authorized Representative Name: ScottHenson <br />Email:etExl.: <br />Slate: WA ZP Code; 98837 <br />Address: 1224 A, Pioneer Way <br />Telephone: (509) 765-1023 <br />Slgnature:Date: 1/ ll /rcc-1 <br />FEMA Form FF-206-FY-22^152 (formerly 080-0-33) (10/22)Page 4 of 19