Laserfiche WebLink
IMPORTANT: ln these spaces, copy the conosponding lnformatlon from Section A.FOR INSUMNCE COMPANY USE <br />Buildlng Street Address (including Apt., Unit, $uile, and/or BldS. No.) or P.O. Route and Box No. <br />2917 Dapplo Gray Way <br />Pollcy Number: <br />Clty State <br />Washington <br />ZIP Code <br />98926 ,Ellensburg <br />Company NAIC Number <br />sEcTloN G -coMMuNITY TNFORMATTON (OPTTONAL) <br />The local oflicial who is authorized by law or ordinance to admlnister lhe community's floodplain managemenl ordlnance can comptete <br />Sections A, B, C (or E), and G of lhls Elevallon Certificate. Complete lhe applicable llem(s) end slgn below. Gheck the measurement <br />used ln llems G8-G10. ln Puerlo Rico only, €nter meters. <br />Gl. fl The information in Section C was laken from olher documenlallon lhat has been slgned and sealsd by a licensed surveyor, <br />engineer, or architect who is au{horized by law to cefifo elevatlon ln{ormation. (lndioate lhe source and date of lhe elevatlon <br />data in the Comments area below.) <br />G2. fl A communlty olficlal completed Seclion E for a bullding located in Zone A (without a FEMA-issued or community-issued BFE) <br />orZone AO. <br />ff. n The followlng information (ltems G4-G10) is provided for communily lloodplain managemenl purposes. <br />G4. Perrnit Number G5. Dat€ Permit lssued G6. Date Cerlificate of <br />Compllance/Occupency lssued <br />G7. This permit has been issuod for: fJ New Construclion I Substantial lmprovemenl <br />G8. Elevalion of as-built lowesl lloor (including basement) <br />of lho building: <br />G9. BFE or (ln zone AO) depth of ltoodlng at lhe bulldlng slte: <br />G10. Communlty's design llood €levalion: <br />I foet I meters Datum <br />flfeet I metero Datum <br />ff feet I meters Darum <br />Local Offioial's Name Tille <br />Gornmunity Name Telephone <br />slgnature Date <br />Comments (including type of equipmenl and localion, per C2(e), if applicable) <br />I Check here if attachments. <br />ELEVATION CERTIFICATE OMB No. 1660"0008 <br />Explration Date: November 30,2022 <br />FEMA Form 086-0-33 {1A$)Replaoes all previous edilions.Fotm Page 4 ofG