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ELEVATION CERTIFICATE oMB No. 1600-0008 <br />Explralion Date: Novemb er 30, 2022 <br />lUtgtlAltT: ln thess spaoos, copy the correspondlng lnformation from Seoflon A.FOR INSUMNCE COMPANY USE <br />Building Slreet Addreeg <br />2911 Roan Drive <br />(lncludlng Apt,, Unlt, Suite, and/or Bldg. No.) or P.O. Route and Box No.Policy Number: <br />cny Slato <br />Washington <br />ZIP Code <br />98926Ellensburg <br />Company NAIC Number <br />SECTION E - BUILDING ELEVATION <br />FORZONEAOAND <br />TNFORMATTON (SURVEY NOT REQUTRED! <br />zoNE A (WTHOUT BFE) <br />ForZones_AO and A (wllhou!BFE)r complete ltems El-E5. lf the Certillcate is intonded to support a LOMA or LOMR-F request, <br />complete Secllons A, B,and C. For ltems E1-E4, use natural grade, if avallable. Check the m6asurement used. ln Puerto Rlco only, <br />enter meterg. <br />E1. Provlde elevatlon lnformation for the followlng and ohec* the approprlate boxee to show whelher the elevation is abovo or belo,rr <br />the hlghest adjaoent grado (HAG) and the lowest adjacent grada (LAe). <br />a) Top of bottom floor (lncluding basement, <br />crawlspace, or enolosure) is <br />b) Top of bottom floor (includlng basemenl, <br />crawlspace, or enolosurQ ls <br />E feet E meters ! above or fl below th6 HAG. <br />fJfeet I metere I above or I bebw lhe LAG. <br />E2. For Building Diagrams 6-9wlth permanontflood <br />the nexl hlgher floor (elevatlon C2.b in <br />the diagrams) of the bulldlng is <br />E3. Attachsd garage (top of etab) le <br />E4, Top of platform of machinery and/or equipment <br />servicing lhe bulldlng 18 <br />openlngs provided in Seclion A ltems 8 and/or g (see pages 1-2 of lnstructlons), <br />flfeet fimeters <br />flfeet I meters <br />Dfeet [meters <br />flabove or Ibetowthe HAG. <br />I above or f]bdow lhe HAG, <br />flabove or flbelow lhe HAG. <br />E5. ZonE AO only: lf no llood deplh number le avallable, is the top of the bottom floor elevated ln accordanoe wlth lho communlty's <br />floodplaln management ordinance? ! Yes I No fl Unknown. fie local officla] must c€rlify this information in gedtion G. <br />sEcTloN F - PROPERTY OWNER (OR OWNER'S REPRESENTATTVEI CERT|F|CAT|ON <br />The property ownelglo-lvner's authorhed representative who completes Seolione A, B, and E for Zone A (without a FEMA-lssued or <br />cornmunity.issued BFE) or Zone AO must slgn here. The statemerils ln Secliong A, b, ind E are correct lci the best of my knowledge. <br />Property Owner or Owne/s Authorlzed Representallve s Name <br />Scott Henson <br />AddreEs <br />1224 S PloneerWay <br />City <br />Moses Lake <br />State ZIP CodeWashlngton S8837 <br />Signalure,,il ' 1,-U-^"" it l.....r'i..sr4z'j /{t1lr(<tr.r/l <br />Date <br />^ /, tt . -'r/lLl/ia7") <br />Telephone <br />(500) 865.51 12 <br />Commente <br />D Check here lf attachments. <br />FEMA Form 086-0-33 (A$l Replaces all prevlous edltlons.Form Page 3 of 6