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IMPORTANT: ln these spac€s, copy the conerpondlng lnformatlon from Seolion A.FOR INSURANCE COMPANY USE <br />Building Street Addrees (lnoluding Apt., Unit, Sulte, and/or Bldg. No.) or P,O. Route and Box No. <br />3004 Depple G.ray Way <br />Pollcy Number: <br />city State <br />Washlngton <br />ZIP Code <br />98926Ellensburg <br />Cornpany NAIC Number <br />SECTION E - BUILD ING ELEVATION INFORMATION {SURVEY NOT REQUI RED} <br />FORZONE AO AND ZONE A(WTHOUT FFE) <br />For Zones AO and A (wilhout BFE), complete ltems E1-E6, lf the Certilioate ia intended to support a LOMA or LOMR-F reguesl, <br />complete Sections An B,and C. For ltems El-E4, use natural grade, if available. Cheok the measuremont used. ln Puerto Rico only, <br />enter meters. <br />El. Provide olevation lnformatlon for lhe followlng and oheok the approprlate boxes to show whether the elevation is above or below <br />lhe highest adjaoent grade (HAG) and lhe lowest adjacent grade (LAG). <br />a) Top of bottom floor (includlng basement, <br />crawlepace, or enclosure) ls <br />b) Top of bottom floor (lncludlng basement, <br />crawlspace, or enclosure) is <br />flfeet Imeters Iaboveor E belowtho l"lAG. <br />E feet E melers I above or E below the LAG. <br />E2. For Buildlng Dlagrams 6-9 wllh pennanent llood <br />the next higher tloor (elevation C2.b ln <br />lhe dlagrams) of the buildlng lB <br />E3. Attached garage {top of slab) ia <br />E4. Top ol platform of rhachlnery and/or equlpment <br />servlcing the building ls <br />openingo provlded in Seotlon A ltems I and/or g (see pages 1-2 of lnslructlons), <br />D feel I melers E above or il below the HAG. <br />I teet ! meters D above or E uelow the HAG. <br />flfeet ilmeters Eaboveor Ebelowthe HAG, <br />86. Zone AO only: lf no llood depth number ls available, is lhe top of lhe bottom floor elevated in accordance wlth lhe community's <br />floodplaln management ordlnance? ff Yes E No f| Unknown, The localofficial must ceili$ lhis lnformallon ln Section G. <br />sEcTtoN F - pRopERry owNER (oR owNER's REPRESENTATIVE) CERTTFTCATTON <br />The orooertv owner or owner'e aulhorized reoreeentatlve who comrleles Seolions A, B, and E for Zone A (without a FEMA-lssued or <br />communttyJssued BFE) or Zone AO must slgn here, Ths etatemedta in Sections A, B, irnd E arc oorect to the besl of my knowledge. <br />Pnoperty Ovner or Owne/s Aulhorlzed Representallve's Name <br />Scott Henson <br />Address <br />1224 S Ploneer Way <br />Clty <br />Moses Lake <br />State <br />Washlngton <br />ZIP Code <br />98837 <br />Date <br />(509) 85&5112 <br />E Cheok here if attachments. <br />ELEVATION CERTIFICATE <br />OMB No. 1660.0008 <br />Expiratlon Datel Novombor 3O,2022 <br />FEMA Form 08&0€3 (12l1gl Replacee all prevlous ediliona,Fom Page 3 of6