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IMPORTANTT ln these apacea, copy the correspondlng informatlon from Sectlon A.FOR INSUMNCE COMPANY USE <br />Bulldlng Slreet Address (lncluding Apt., Unit, Suile, and/or Bldg. No,) or P.O. Roule and Box No. <br />291{ Roan Drlve <br />Policy Number: <br />State <br />Washington <br />ZIP Code <br />98926 <br />Clty <br />Ellensburg <br />Company NAIC Number <br />SECTION G - coIrrlMUNlTY INFoRMATIoN (oPTIONAL) <br />The local ofllclal who ls authodzed by law or ordinance to admlnlster lhe community's lloodplain management ordlnance can complete <br />Sectlon$ A, B, C (or E), and G of this Elevation Geilifioate. Cbrnplele the applicabld item(s)'and sign below. Chack the measurembnt <br />used in ltems G8-G10. ln Puerto Rlco only, enler meters. <br />Cl. fl The lnfonnation in Seolion C was taken from other dooumentation lhal has been signed and sealed by a licensed surveyor, <br />englnear, or architect who ls authorlzed by law lo certlff ebvation lnformatlon. (lndlcate the source add date of the elevitlon <br />dala ln the Comments area below.) <br />G2, E fr?Jl3[gy *cial completed Seolion E for a building located ln Zone A (without a FEMAJssued or community-iesued BFE] <br />93. I The following lnformalion (ltems GGG10) ls provided for community floodplain managament purpoess. <br />G4, Pemit Number G5. Date Permit lssued G6. Date Certlflcate of <br />Compllance/Occupancy lssued <br />G7. Thls permlt has been lssued for; [| New Conetruclion ! Substantial lmprovement <br />G8. Elevation of as-built lowest floor {including basement) <br />of the building: <br />G9. BFE or (ln Zone AO) depth of floodlng at lhe building site: <br />G10, Communily's deslgn flood elevatlon: <br />flfeet f, metere Datum <br />E teet I metere Datum <br />I feet ! meters Datum <br />Looal Oflicial's Name Tltls <br />Community Namo Telephone <br />Date$lgnalure <br />Comments (lncludlng gpe of equlpment and locallon, per C2(e), if applicable) <br />fl Check here if atlachments, <br />ELEVATION GERTIFICATE No.1660-0008 <br />Date: November30,202;2 <br />FEMA Form 086-0-33 (12119)Replaceo all previous edilions.Form Page4 ofO