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IMPORTANT: In these spaces, copy the correspondlng lnformation lrom Sectlon A.FOR INSURANCE COMPANY USE <br />Building StreetAddress (inc{uding Apt., Unit, Suite, and/or Bldg. No.) or P.O. Route and Box No. <br />3008 Dapple Gray Way <br />Policy Number: <br />City State <br />Washington <br />ZIP Code <br />98926Ellensburg <br />Company NAIC Number <br />sEcTroN c - coMMuNtTy TNFoRMAT|oN (opTtoNAL) <br />The looal official who is authorized by law or ordlnance to administer the communiiy's lloodplaln management ordinance can complete <br />Seotions A, B, C (or E), and G of thie Elevation Certiffcate. Complete the applicable item(s) and sign below. Check {he measurement <br />used in ltems G8-G'10. ln Puerto Rlco only, ent€r meters. <br />G1. n The informatlon in Seotion C was laken from olher documerrtation that has been signed and sealed by a licensed surveyor, <br />engineer, or architect who is auhorked by law to oertity elevalion information. (lndicate the source and date of the elevatlon <br />data in the Comments area below) <br />G2.fl A communily official completed Sestion E lor a building located in Zone A (without a FEMAlssued or community-issued BFE) <br />or Zone AO. <br />Gg. D The following information (ltems G4*G10) is provided for community floodplain management purposes. <br />G4. Permlt Number G5. Date Permit lssued G6. Date Certificato of <br />Compllance/Oocup€ncy lssued <br />G7. Thls permlt has been lssued for: E New Construction I Substantial lmprovement <br />G8. Elevstlon of ae-bullt lowest floor (including basement) <br />of the bullding: <br />G9. BFE or (in Zone AO) depth of flooding at the bulldit'rg slte: <br />G10, Community's design llood elevation: <br />flfeet ! meters <br />! feet I meters <br />! feet flmeters <br />Datum <br />Datum <br />Datum <br />Local Offldal's Name Tlte <br />Community Name Telephone <br />Signaturo Date <br />Comments (includlng type of equlpment and locaton, per C2(e), lf appllcable) <br />f] Check horo if attachmonts. <br />ELEVATION CERTIFICATE OMB No. 1660-0008 <br />Expiralion Date: November 30,2022 <br />FEMA Form 086-0-33 (12l19l Replaoes all previous editions.Form Page4 of6