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ELEVATION CERTIFICATE <br />IMPORTANT: MU$T FOLLOWTHE INSTRUCTIONS ON PAGES 9.19 <br />FOR INSURANCE COMPANY UgEBulldlng Streel Address (lncludlng Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No.: <br />2915 Dapple Gray Way <br />City:Ellensburs State: WA ZP Gode: 98926 <br />Company NAIC Number: <br />Pollcy Number: <br />For Zones AO, AR/AO, and A (wilhout BFE), compleie llems E1-E6, For ltems E1-E4, use natural grade, jf available. lf the Certificate is <br />intended to support a Letter of Map Change requesl, complete Seclions A, B, and G. Check the measuremenl used. ln Puerto Rlco only, <br />enter meters, <br />Building measuremenls ere based on; I Constructlon Drawings* [ auitCing Under Consbucl'on* [] Finlshed Conslruclion <br />"A new Elevalion Certificate will be required when construclion of the buitding is mmplete, <br />E1. Provide meaouromenls (C,2.a in applicable Building Diagram) for lhe following and cheok the appropriate boxes to show whelher ihe <br />measuremenl is ebove or below the nalural HAG and the LAG, <br />a) Top of boltom floor (including basement, <br />crawlspace, or enclosure) ls: tr feet I melers I above or f] betow the HAG. <br />b) Top of boltom floor (including basement, <br />crawlspace, or enclosure) ls: I feet ! melers f] above or I below the LAG. <br />E2. For Buildlng Diagrams 6-9 with permanenl flood openings provided in Section A ltems I and/or 9 (see pages 1-2 of <br />I feet I meters fJaboveor I belowlheHAG. <br />E5, Zone AO only: lf no flood depth number is available, is the top of the bottom floor elevated ln accordance wlth lhe communlly's <br />floodplain management ordinanoo? fl Yes n No I Unknown The local official musi certify thls infonnation in Seclion G. <br />n <br />lnstructions), the <br />I feet meters fl above or below the HAG. <br />nexi higher lloor (C2.b in applicable <br />Buitding Diagram) of lhe building ie; <br />E3. Attached garage (lop of slab) ls: <br />E4. Top of platform of machinery and/or equipment <br />serviolng lhe bullding ls:fl feet I melers I above or I below lhe HAG. <br />The property owner or ownorrs aulhorized represenlative who compleles Sections A, B, and E for Zone A (wilbout BFE) or Zone AO must <br />sign here. The stalements ln SecllonsA, B, and E are correctlo the best of my knowledge <br />I Check here if attachments and describe ln the Commenls area, <br />Propedy Owner or Owne/s Authorlzed Representallve Name: Scott Henson <br />Cityr Moses Lake <br />Emall: shenson@wpeinc.netExt.: <br />Gomments: <br />oa.rl; 4 / /4j/p+7 <br />state; wA ZIP code: 98837 <br />Telephone: (509) 765'1023 <br />Signature: <br />Addressr 1224 S. Pioneer Way <br />FEMA Form FF-206-FY-22-152 (formerly 086-0-33) (10/22)Page 4 of 19