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IMPORTANT: ln thege e pacea, aopy the correepondlng informatlon from Section A.FOR INSURANCE COMPANY USE <br />Bullding $treet Address (includlng Apt., Unll, Sulte, and/or Bldg. No.) or P.O. Route and Box No. <br />3004 Dapple GrayWay <br />Policy Number: <br />City State <br />Washlngton <br />ZIP Godo <br />98926Ellensburg <br />Company NAIC Number <br />sEcTtoN G -coMMuNrw TNFoRMAT|ON (OPT|ONAL) <br />The local offlcial wtro ls authotlzed by law ot ordinanc€ lo administer the communlt/s floodplaln management ordlnance can complete <br />Sections A, B, Q (or E), and G of thls Elevation Certificate, Gomplete the applioable ltem(s) and sign below. Oheok lhe moasurement <br />used ln lteme G8-G10. ln Puerto Rlco only, enter metere. <br />G 1 . D The lnfomallon ln Seolion C was taken from other documentatlon that has been slgned and sealed by a licensed Burv€yor, <br />englneer, or archltecl who le authorlzod by law to cerllff elevatlon lnformallon. (lndlcale the sourco and date of the elevalion <br />data in lhe Commenls area below.) <br />C2. n fr?fif;fty "*lal completed Sectlon E for a bulldlns loceted ln Zone A (wllhout a FEMA-issued or communlly-lssued BFE) <br />63. D The fotlowlng informalion (ltems G4-G1O) ls provided for communig floodplain management purposes. <br />G4. P€rmlt Number G5. Date Pennlt lssued G6. Dale Cerlilicate of <br />Compliance/Oc,cupancy lssued <br />G7, Thi$ pemit has beon issued for: [] New Conslruclion fl Substantial lmprovement <br />G8. Elevatlon of as-buill lowest floor (including basement) <br />of the buildingr <br />c9. BFE or (in Zone AO) depth of llooding at the bullding site: <br />G10. Community's deslgn flood elevation: <br />! feet I metets Datum <br />! feet I meters Datum <br />I feet I mebrs Datum <br />Local Offlclal'e Name Tltle <br />Communlty Name Telsphone <br />Signature Date <br />Commenls (lncluding type of equlpment and locatlon, per C2(e), if applicable) <br />I Check here if altachments. <br />ELEVATION CERTIFICATE OMB No. 1660-0008 <br />Explralion Date November ?O,2022 <br />FEMA Form 086-0-33 (12119')Replaces all prevlous editions.Form Page 4 of 6