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IMPORTANT: ln these spaces, copy lhe corresponding lnformatlon from Section A.FOR INSURANCE COMPANY USE <br />Bulldlng Street Address (hcludlng Apt., Unit, Sulte, and/or Bldg. No.) or P,O. Route and Box No. <br />2919 Roan Drive <br />Pollcy Number: <br />clty State <br />Washlngton <br />ZIP Code <br />98926Ellensburg <br />Company NAIC Number <br />sEcTtoN G - coMMuNtw I{FoRMAT|ON (OPT|ONAL} <br />The local offlclal who le authorlzed by law or ordinance to admlnlster lhe communlty's floodplaln management ordlnance can complete <br />Seotions A, B, C (or E), and G of thls Elevatlon Cerlificate. Complete lhe appllcable ltem(s) and sign below. Check tre measurembnl <br />used in ltems G8-G10. ln Puerto Rico only, enter meters. <br />Gf . E The lnformatlon ln Sectlon C was taken from olher documentation thal has been slgned and sealed by a llcensed surveyor, <br />englneer, or architeot who lE aulholzed by law to oerli! elevatlon informalion. (lndloate the source and date of lhe slovallon <br />data ln the Commenls area below.) <br />G2. E A qlmmunity ofliclal completed Soction E for a buildlng loosted ln Zone A (without a FEMA-lssued or community-iesued BFE) <br />or Zone AO, <br />63. fJ The followlng lnformatlon (llems G4-G10) ls provlded for communlg floodplaln managemenl purposes. <br />G4. Permit Number G5. Date Permit lssued G6. Date Certlficate of <br />Compliance/Occupancy leeued <br />G7. Thls permit has been issued for: [f New Construction ! Subslantial lmprovement <br />G8. Elevatlon of as-bullt lowesl floor (lncluding basement) <br />of the buildlng: <br />G9. BFE or (ln Zone AO) deplh of flooding at the building site: <br />G10. Community'e design llood elevation: <br />flfeet I meters Datum <br />I feet f] meters Datum <br />I feet I meters Datum <br />Looal Ofliclal's Name Tltle <br />Communlty Name Telephone <br />Signature Dale <br />Comments (lncludlng gpe of equlpment and loaatlon, per C2(e), lf applicable) <br />I Cheok herc lf attac'hments. <br />ELEVATION CERTIFIGATE OMB No. 16604008 <br />Expiralion Dale: Novembat 30, 2A22 <br />FEMA Form 086-0-33 (12115)Replaces all prevlous edllions,Form Page 4of6