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ELEVATION CERTIFICATE <br />IMPORTANT: MUST FOLLOW THE INSTRUCTIONS ON PAGES 9.19 <br />FOR INSURANCE COMPANY USEBuilding Street Address (including Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. <br />3003 Dapple Gray Way <br />City:Ellensburg Slate: WA ZtP Code: 98926 <br />Company NAIC Number: <br />Policy Number <br />sEcTloN G - coMMuNrTY TNFORMATION (RECOMMENDED FOR COMMUNTTY OFF|C|AL COMPLETTON) <br />The local official who is aulhorize{by law or ordinance to administer the com.munity's floodplain management ordinance can complete <br />Section A, B, C, E, G, or H of this Elevation Certificate. Complete the applicable itein(s) and sign beloW when: <br />G1. fl fne information in Section C was taken from other documenlation that has been signed and sealed by a licensed surveyor, <br />engineer, or architecl who is authorized by state law to cerlify elevation inlormation. (lndicate the source and date of the <br />elevation data in the Comments area below.) <br />G2.a. f, A local official completed Section E for a building located in Zone A (without a BFE), Zone AO, or Zone AR/AO, or when item <br />E5 is completed for a building located in Zone AO. <br />G2.b. E A bcal official completed Section H for insurance purposes. <br />G3. fJ tn ttte Commenls area of Section G, the local official describes specific corrections to the information in Sections A, B, E and H <br />G4. E ff," following information (ltems GS-G11) is provided for community lloodplain management purposes. <br />G5. permit Number: FD-22-00010 G6. Date perml tssued- 0310212022 <br />G7. Date Certificate of Compliance/Occupancy lssued: <br />G8. This permit has been issued for: El ru"* Construction n Substantial lmprovement <br />G9'a. Ebvation of as-built lowest floor (including basement) of lhebuilding: 1,594.10 fi teet I meters Datum: NAVD lggg <br />G9.b. Elevation of bottom of as-built lowest horizontal structural <br />member: <br />G10,a. BFE (or depth in Zone AO) of flooding at the building site; <br />G10.b' gornlunity's minimum elevalion (or depth in Zone AO) <br />requirement for the lowest floor or lowest horizontal struclural <br />member: <br />[] feet <br />1,591.60 S feet Datum: NAVD 1988 <br />1,592.60 Eteet Imeters Darum: NAVD 1988 <br />G11. Variance issued? [ Ves EJ ruo lf yes, attach documentalion and describe in the Comments area. <br />The local olficial who provides information in Section G must sign here. I have. completecl thg information in Seclion G and cedify that it is <br />correct to the besl of my knowledge. lf applicable, I have also provided specific corrections in the Comments are€ of this section. <br />Local Oflicial's Name: Samantha Cox Tile: Water Resources Specialist <br />NFIP Community Name: Kittilas Countv <br />I meters <br />I meters <br />Datum <br />Telephone: (509) 962'7523 <br />Address:411 N Ruby St, Suite 1 <br />Ext,; _ Email publicworks@co. kittilas.wa.us <br />City:Ellensburg State; WA Ztp Code: 98926 <br />Signature:Date <br />Commenls (including type of equipment and <br />Sections A, B, D, E, or H): <br />per C2,e; description of any attachments; and corrections to specific inlormation in <br />ql\\,tb <br />FEMA Form FF-2O6-FY-22-152 (formerly 086'0-33) (10122)Page 5 of 19