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ELEVATION CERTIFIGATE <br />IMPORTANT; MUST FOLLOW THE INSTRUCTIONS ON PAGES 9.19 <br />FOR INEUMNGE COMPANY USEBuildlng Street Address (lncludlng Apt., Unit, Suite, andior Bldg. No,) or P.O. Route and Box No.: <br />_. 2905 Dapple Gray Way <br />City:Ellensburs Slale: WA ZP Code: 98926 <br />Company NAIC Number: <br />Policy Number: <br />For Zones AO, ARfAO, and A (wllhout BFE), complele ltems E1-E6. For ltems E1-E4, use na{ural grade, if available, lf the Ceriifioate is <br />lntended lo support a Letler of Map Change request, complele Sections A, B, and C. Gheck the measuremenl used. ln Puerto Rico only, <br />enter meters, <br />Building measurements are based on: I Conelructlon Drawings* [ auitOing Under Construction* @ Flnlshed Construclion <br />*A new ElevaUon Cediflcate will be requlred when construction of the building is complete. <br />E1. Provide measurements (C.2.a in applicable Bullding Diagram) for the following and oheok the appropriate boxes to show whether the <br />measurement ls above or below the natural HAG and lhe LAG. <br />F2. For Bulldlng Dlagrams 6-9 wlth permanent flood openings provlded ln Sectlon A l(ems 8 and/or g (see pages 1-2 of lnslruotions), the <br />E3. Altachedgarase(lopof slab) is: l] feet f] meters I aboveor I belowtheHAG, <br />E4. Top of platfotm of machlnery and/orequipment <br />seruioing the building ls: f] feet f] meters I above or I below the HAG, <br />E5. Zone AO only: lf no flood depth number is avallable, is the lop of lhe boltom Roor elevated ln accordance with ihe community's <br />lloodplaln management ordinance? [ Yes fl No E Unknown The local offlclal musl certlry ftis lnformallon ln Sectlon G. <br />a) Top of bot{om floor (including basoment, <br />crawlspace, or enclosure) is: <br />b) Top of botlom floor (including basement, <br />crawlspace, or enclosure) is: <br />I feet f] meters I above or fl below the HAG. <br />I feet I motors I above or f] below the LAG. <br />next higher floor {C2.b ln appllcable <br />Building Diagram) of the building is:I feet I meters fl above or ! below (he HAG. <br />The property owner or owner's aulhorized represenlalive who compleles Sections A, B, and E for Zone A (without BFE) or Zone AO must <br />sign here. Ihe statemenls in Seclions 4 B, and E are corrcct lo the bost of my knowledge <br />fl Check here if attachments and describe in the Comments area. <br />Property Owner or Owne/s Authorized Represenlalive Name: Scott Henson <br />Date:4,1q,/n"*7 <br />Comments: <br />Email: shenson@wPelnc.net <br />City:Moses Lake <br />Address: 1224 S, Ploneer Way <br />Signature: <br />State: WA ZIP Code: 98837 <br />Telephone: (509) 765'1023 Ext: <br />FEMA Form FFA08-FY-22-152 fformerly 0864-33) (10/22)Page 4 of 19