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IMPORTANT: ln lhese 6paces, copy the corresponding informallon from Secllon A,FOR INSURANCE COMPANY USE <br />Bulldlng Slroel Address (including Apt., Unlt, Suite, and/or Bldg, No.) or P.0. Route and Box No. <br />3006 Dapplo Gray Way <br />Policy Number: <br />City Slale <br />Washington <br />ZIP Code <br />98926Ellensburg <br />Company NAIC Number <br />sEcTloN G - coMMUNtTy TNFORMATTON (OPT|ONAL) <br />The local officlal who ls aulhoriz€d by law or ordinance to administer the community's floodplain management ordlnance oan complste <br />Secllons A, B, C (or E), and G of thls Elevation Certificale. Complete ihe applicable item(s) and sign below. Check the measurement <br />us€d in ltems GB-G10. ln Puerto Rico only, enter meters. <br />G1. U The informalion in Seclion C was taken from other documenlation that has been signed and sealed by a llcensed surveyor, <br />engineer, or architect who is aulhotized by law lo cerlify elevatlon informalion. (lndicate llre source and date of lhe elevalion <br />data ln lhe Comments area below.) <br />c2. fl <br />G3. I <br />A community of{icial completed Section E for a building located in Zone A (wilhout a FEMAissued or community-issuod BFE) <br />or Zone A0. <br />The following informalion (ltems G4-G10) is provided for communlty floodplain management purposes. <br />G4. Permit Number G5. Dale Pormit lssued G6. Date Certilicate of <br />Gompliance/Occupancy lssued <br />G7. This permil has been lssu€d lor: fl New Construction E Subslanlial lmprovement <br />GB. Elsvatlon of as-bullt lowest floor (lncluding basement) <br />of lhe buildlng: <br />G9. BFE or (in Zone AO) depth of flooding al lhe bullding slte: <br />G10. Community's design llood elovation: <br />I feet I moters <br />fl feet fl meters <br />I fool f] melers <br />Dalum <br />Dalum <br />Dalum <br />Local Offlcial's Name Tille <br />Communily Name Telephone <br />Slgnature Dala <br />Comments (lncludlng typo of equlpment and locatlon, per C2(e), lf appllcable) <br />fl Check here if attachmenls. <br />ELEVATION CERTIFICATE OMB No. 1660-0008 <br />Expiration Date: November 30,2022 <br />FEMA Form 086-0-33 (12l19)Replaces all previous €ditions.Form Page 4 of 6