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IMPORTANT: ln theae spaces, copy the oorrespondlng lnformatlon from Seollon A.FOR INSURANCE COMPANY USE <br />Bullding $treet Address (including Apt., Unil, Sulte, and/or Bldg. No.) or P.O. Route and Box No, <br />2911 Roan Drive <br />Pollcy Number: <br />clty State <br />Ellensburg Washington <br />ZIP Code <br />98926 <br />Company NAIC Numbet <br />SECT|ON C - BUILDING ELEVATTON TNFORMATTON (SURVEY REQUTRED) <br />C1. Bulldlng elevatlons aro based on: I Construction Drawlngs* [ Buildlng Under Gonstrucllonr B ftnfned Construollon <br />!\ new Elevatlon Cerlilicate wlll be requhed when constructlon of the bulldlng ls complete, <br />C2, Elevations - Zones A{-A30, AE, AH, A (wllh BFE), VE, V1-V30, V (wllh BFE}, AR, AR/A, AR/AE, AR/A1-A30, AR/AH, AR/AO. <br />Complete ltems C2,a-b below according to lhe building diagram specilied in lteft A7. In Puerto Rlco only, enter metors. <br />Benchmark Utlllzed: Center of S 27 T 18 N, R 18 E VertlcalDalum: NAVD tS88 <br />lndicate elevatlon daturn used for lhe elevations in items a) through h) below. <br />fl NGVD 1929 El NAVD 19ss flother/Sourcer <br />Datum used for building elevallons must be the same as that ueed for the BFE. <br />Chsok ths measurem'nt us€d. <br />a) Top of botlom fioor (lncludlng basement, crawlspace, or enclosure tloor) <br />b) Top of lhe next hlgherlloor <br />o) Boftom of lhe lowest horizontal struclural member (V Zones only) <br />d) Attached garage (top of slab) <br />e) Lowest elevation of machlnerv or eoulomeni serviclno {he bulldlno' (Dedcrlbe type of equlpment rind locratlon ln Commenle) <br />f) Loutest adjacent (finished) grade next to building (LAG) <br />g) Hlghest adjacenl (linished) grade next to bullding (HAO) <br />h) Lowest adfacent grade at lowest elevation of deck or slairs, includlng <br />etructural support <br />r 601.3 I feet I melers <br />N/A I feet I meters <br />N/A I feet fl meters <br />1601.3 @ feet I meters <br />1601.s <br />N/A E feet fl meters <br />1599,8 <br />@ feet <br />@ feet <br />[] feel <br />! meters <br />I meters <br />fl meters1600.6 <br />SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION <br />Thls certllicatlon ls lo be signad and s€aled by a land survoyor, englneer, or erchitect authorized by law to certify elevation lnformatlon, <br />I certlfy that the .lnformatbn on thig Certillcaki rcpresonls my besl etforls to lnterpret lhe data avallhble, I underdtand that any falso <br />slatemenl may ba punishable by llne or imprlsohmont undeir tA U,S. Code, Secllon 1001, <br />Were latltude and longltude ln Secllon A provlded by a llcensed land suweyor? ElYes fJ tto n Check here if attachments, <br />Cerllfle/s Name <br />Rick Skinner <br />Licenso Number <br />436.19 <br />I I <br />TUe <br />Professional Land Surveyor <br />Company Name <br />Weslern Paclflo Englneerlng & Survey, lnc. <br />Address <br />1224S. Ploneer Way <br />Clty <br />Moees Lakf\ <br />r", <br />gtate <br />Washlngton <br />ZIP Code <br />98837 <br />Date Telephone <br />(509) 765-1023 <br />Ext. <br />l <br />Copy all pdges of tfils Elevallon Goillflcate and allattachmonts fo/(1) coftmurfity offlclal, (2) lnsunnoe agenUcompany, and (3) bulldlng owner, <br />Comments (including type of equipment and locatlon, per C2(e), if applicable) <br />The elevation of the heat pump located outside of home wae measured by uslng a GPS and lhen adding the height of the legs for the <br />heat pump. <br />ELEVATION CERTIFICATE OMB No, 1660-0008 <br />Explratlon Date: Novemb et 30, 2022 <br />FElvlA Form 086-0-33 (12/19)Replaoes all prevlous editlons.Form Page 2 of6