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IMPORTANT: ln these spaces, copy lhe correspondlng lnformafion from Sectlon A.FOR INSURANCE COMPANY USE <br />Bulldlng Slreet Address (including Apt., Unlt, Suite, and/or Bldg. No.) or P.O. Route and Box No. <br />30'12 Dappte Gray Way <br />Policy Number; <br />City State <br />Washington <br />ZIP Code <br />98926Ellensburg <br />Company NAIC Number <br />sEcTloN G - coMMuNlTy TNFORMATTON (OPTIONAL) <br />The local offlclal who ls authorized. by law or ordinance to administer the communlty's lloodplain managemant ordinance oan complete <br />Sections A, B, G (or E), and G of thls Elevation Cerlificate. Complete the applicable item(s)'and slgn bdow Check the moasurem'ent <br />used ln ltems G8-G10. ln Puerto Rico only, enter motors. <br />G1. n The lnformation in Soction C was laken from olherdocumentation that ha$ been signed and sealed by a llcensed surveyor, <br />engineer, or architect who is authorized by law to certify elevation informalion. (lndicate the soutce and dale of the elevirlion <br />dala ln the Commenls area below.) <br />G2. I A community oflioial completed Seclion E for a buildlng tocated in Zone A (wilhout a FEMA.issued or oommunity-issued BFE) <br />or Zone AO- <br />Gg. tr The foilowing informallon (llems G4-G10) ls provided for community lloodplaln management purposes. <br />G4. Permit Number G5. Date Permit lssued G6. Date Cerlilicate of <br />Compliance/Occupancy lssued <br />G7. Thls permll has been issued for: fl New construcfton fl substantial lmprovement <br />GB. Elevatlon of as-built lowest floor (including basement) <br />of the bullding: <br />G9. BFE or (in Zone AO) depih of flooding at the buildlng site: <br />G10. Community's design flood elevation: <br />I feet I meters Datum <br />I teet I meiers Datum <br />I feet I meters Datum <br />Local Ofllclal's Name Title <br />Communlty Name Telephone <br />Signature Date <br />Gomments (including type of equipment and localion, per C2(e), lf appllcable) <br />f] Check hero if atlachmenls. <br />ELEVATION CERTIFICATE OMB No. <br />Expiralion <br />1660-0008 <br />Oate: November 34,2022 <br />FEMA Form 086.0-33 (12115)Replaces all prevlous €dltlons.Forrn Page 4 of 6