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IMPORTANT: ln lhese Epaces, copy the correspondlng lnformatlon from Sectlon A FOR INSURANCE COMPANY USE <br />Building Slreet Address (including Apt., Unil, Suite, and/or Bldg. No.) or P.O. Routo and Box No. <br />2917 Dapple Gray Way <br />Pollcy Number: <br />City Stale <br />Washington <br />ZIP Code <br />98926Ellensburg <br />Company NAIC Number <br />sEcTtoN E - BUTLD|NG ELEVATTON TNFORMATTON (SURVEY NOT REAUTRED) <br />FOR ZONE AO AND ZONE A (W|THOUT BFE) <br />For Zones AO and A (wilhout BFE), complele ltems E1-E5. lf the Corlificate ls inlended to supporl a LOMA or LOMR-F r€quesl, <br />complele Seclions A, B,and C. For llems E1*E4, use nalural grade, if avallable. Check lhe measurement used. ln Puerto Rico only, <br />enter molers. <br />El. Provide elevation lnformation for lhe following and check the appropriate boxos lo show whether lhe elovalion is above or below <br />the highost adJacent grade (HAG) and tho lowesl adJaconl grade (LAG). <br />a) Top of bottom floor (including basement, <br />crawlspace, or enclosure) is <br />b) Top of bottom floor (including basement, <br />crawlspace, or enclosure) ls <br />I feet f] meters fl above or I below the HAG. <br />I feet I meters f] above or f] below lhe LAG. <br />E2. For Building Diagrams 6-9 wilh permanent <br />lho nexl highor lloor (elevalion C2,b ln <br />lhe diagrams) of tho bulldlng ls <br />E3. Altached garage (top of slab) is <br />llood openings provided in Soclion A llems B and/or g (seo pages 1-2 of lnslruclions), <br />I feet I meters I above or f]below lhe HAG. <br />I feei f]meters flabove or flbelow the HAG. <br />E4. Topof platform of machinery and/or equipment <br />seryicing the building is flfeet I metors f] above or flbelow the HAG. <br />E5. Zone AO only; lf no llood depth number ls avallable, ls the top of lhe bottom floor elevated in accordance with the community's <br />lloodplain managemenl ordinance? [ Yes I No f] Unknown. The local oflicial must cerlify thls information ln Section G. <br />sEcTloN F - PROPERTY OWNER (OR OWNER'S REPRESENTATTVE) CERT|F|CAT|ON <br />The property owner or owner's aulhorized represenlalive who completes Seclions A, B, and E lor Zone A (wilhoul a FEMA-issued or <br />community-issued BFE) or Zone AO must sign here. The statemenls in Seclions A, B, and E are correcl t<i lhe best of my knowledge. <br />Property Owner or Owne/s Authorized Represenlallvo's Name <br />Scott Henson <br />Address <br />1224 S. Ploneer Way <br />City <br />Moses Lake <br />State <br />Washington <br />ZIP Code <br />98837 <br />Signature -.*-tr--Zlr**r,t Dale <br />6/9/y>t <br />Telephone <br />(50e) 765-1023 <br />Commenls <br />il Check here if atlachmenls. <br />ELEVATION CERTIFICATE OMB No. 1660-0008 <br />Expirallon Dalol November 30,2022 <br />FEMA Form 086-0-33 (12119)Roplaces all previous edilions.Form Page 3 of 6