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IMPORTANT: ln there spacos, copy the coresponding lnformatlon from Section A,FOR INSURANCE COMPANY USE <br />Bulldlng Street Addrees (lnoludlng Apt., Unit, Sulte, and/or Bldg. No.) or P.O. Route and Box No. <br />2916 Roan Drive <br />Polioy Numben <br />City State <br />Washlngton <br />ZIP Code <br />98926Ellensburg <br />Company NAIC Number <br />sEcTlON G - GoMMUNIW |NFORiIIATION (OPTIONAL) <br />The local ofticlal who is authorlzed by law or ordlnance to admlnlster the communl$'e floodplaln management ordlnance can completo <br />$ecllons A, B, C (or E), and G of thls Elevallon Certificate. Complete the appllcable ltem(s) and slgn below. Check the moasuremenl <br />used in ltems G8-G10. In Puerto Rlco only, enler melers. <br />G1. E The lnlormatlon in Section C was taken fiom other documentalion lhat has been signed and sealed by a licensed surv€yor, <br />- englneer, or archltect who ls authodzed by law to certlfy elevatlon lnformatlon, (lndlcate lhe sourc€ and date of lhe elevallon <br />data in the Commonls area below.) <br />c2. n fr?;xfltsy "fflclal <br />completed Sectlon E for a building located ln Zone A (wllhout a FEMA-issued or communlly-iseued BFE) <br />G3. E The following information (ltems Grrclo) ia provlded for communlty lloodplain management purposes. <br />G4. Permit Number G5. Date Permlt lssued G6. Dale Certlflcate ol <br />Complianoe/Occupanoy lssued <br />G7. This permit has been lssued for: P New Construcllon I Substantial lmprovement <br />c8. Elevallon of as-built lowesl floor (lncludlng basement) <br />of the bulldlng: <br />GS. BFE or (ln Zone Ao)deplh of flooding at lhe bullding site: <br />G10. Gommunlty's deslgn flood elevalion: <br />fl feet I meters Datum <br />I feot I meters Dalum <br />I feet f]meters Datum <br />Local offtclal's Name Tltle <br />Communlty Name Telaphone <br />Slgnature Date <br />Comments (lncludlng type of equipment and locallon, per C2(e), if appllcable) <br />I Check here if attachments. <br />ELEVATION CERTIFICATE <br />OMB No. 1060-0008 <br />Explration Dale: November 30, 2022 <br />FEMA Form 086-0-33 (A191 Replaces all prevlous editions.Form Page 4 of 6