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IMPORTANT: ln these spacesr coFv the correspondlng lnformatlon from Seolion A.FOR INSURANCE COMPANY USE <br />Bulldlng Street Addrees (includlng Apt., Unlt, Suite, and/or Bldg. No.) or P.O. Route and Box No. <br />3010 Dapple GtayWay <br />Policy Number: <br />Clty State <br />Washlngton <br />ZIP Code <br />98926Ellensburg <br />Company NAIC Number <br />sEcTtoN G - coMMuNlTy |NFoRMATION (OPT|ONALI <br />The looal offlolal who le authorlzed by law or ordinanoe to admlnlster the communlty'e floodplaln managemeni ordlnance can complete <br />Sections A, B, C (or E), and G of thls Elevation Cerliflcate. Complete the appllcable item(s) and slgn below. Check the measuremenl <br />ueed ln ltems G8-G10. ln Puerto Rico only, enter meterg. <br />G1. D The lnformatlon in Seciion C was taken from other documentallon that has been signed and sealed by a llcensed survelltlr, <br />englneer, or archltect who ls authorlzed by law to cetllff ebvatlon informalion. (lndlcate lhe source ard date of the elevation <br />data ln lhe Goinments area below.) <br />c, tr A community oftioial compleled Sectlon E for a building located ln Zone A (wllhout a FEMAplssued or communlty-lssued BFE) <br />or Zone AO. <br />Ca. E The following informatlon (ltems G,l-G10) is provlded for community floodplain management purpoees. <br />G4, Permlt Numbsr G5. Date Pormit lseued G6. Date Gertfficats ol <br />Gompllance/Occupanay lssued <br />G7. Thls permlt has been lssued fon @ New Conslructlon f] Subslantial lmprovement <br />G8. Elevalion of as-bullt loirrest floor (includlng basement) <br />of the bulldhg: <br />c9, BFE or (in Zone AO) depth of flooding at the bullding slte: <br />G10. Communlty's deslgn llood elevalion: <br />I feet f] meters Datum <br />I feet ! meters Datum <br />I feet ! meters Datum <br />Local Official's Name Tltle <br />Communig Name Telephone <br />Slgnature Date <br />Comments (lrtcluding type of equipmenl and locallon, per C2(e), lf appllcable) <br />I Cheok here lf attachmente. <br />ELEVATION CERTIFICATE <br />OMB No.1660-0008 <br />Expkatlon Date: November 30,2022 <br />FElr4A Form 080-0-33 (12119)Replaces all prevlous editiong,Form Page 4 ofG