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ELEVATION CERTIFICATE <br />IMPORTANT: MUST FoLLOW THE tNSTRUCT|ONS ON PAGES 9.1S <br />FOR INEURANCE COMPANY USERulldlng slroel Address (including Apl., unll, sulto, and/or Bldg, No,) or 1,.o. Roulo and Box No.; <br />3007 Roan Dr. <br />Clty:Ellensburg Stalo: WA ZIP Codo: $8926 <br />Company NAIG Numbsr; <br />Pollcy Number: <br />fl construction Drawings' l] Bullcllng under conslruclion. [J Flnlshod conslrucllon <br />required whon conslrrrcllon ol the building ls complele. <br />lndicale elevatlon dalum used for tho €lovallons ln lrems a) through h) below. <br />[:l NGVD 1e2s El NAVD le8s [ 0ther: <br />C1. Buildir4 olsvations are baeed on: <br />'A new Elevallon Gertificale wlll be <br />C2. Elsvslions -Zones At-A30, AE, AH. AO, A (with BFE), VE, V1-V00, V (wth BFE), AR, A|VA,AR/AE, AR/A1-A30, AR/AH, AFYAO,A99. Complote llems C2,a-h below according lo the Buitding Diagram spoclfled ln ltem A7, ln Fuerlo Rlco only, enler msl€rs, <br />Benchmark Utillzad: Center of S 27,T 18 N, R 18 E Vorlical Dalum: NAVD 1988 <br />Datum used for bulldlng elovallons rnusl be lhe same as that used for tho BFE. Conversbn factor used?lf Yes, describa lhe source of lhe converslon lsclor in lho geoilon D commenls aroa. <br />a) Top of bollom lloor (incruding basemenl, crawlspaoe, or enclosure lroor): <br />b) Top of the nexl hlgher lloor (see lnslrucilons): <br />c) Botlom of the lowest horizonlal slruclural membor (soo lnslructlons): <br />d) Atlached garage (top of slab): <br />e) lgwesl elevarion ol Machlnory and Equlpment (M&E) servloing lhe buildlng(descrlbe lypo of M&E and loiallon ln bdcilon O Cornments arlall <br />f) Lowest Adjacont Grade (LAG) nexl to bulldingl I Naturat [J finisnert <br />g) Hlphosl AdJacent Grade {HAG) noxl lo bulldlng; I Natural I flntstreO <br />h) Flnlshed LAG al lowesl elevalion of allached deck or slalrs, lncludlng slrucluralsupport: <br />-il4 <br />,1,600.30 <br />N (k I leel fl melers <br />1,600.30 @ faet I meten <br />._.!600.10 <br />1,598.90 <br />[J feet I meters <br />llJ feel I mators <br />1,600.00 lB foet I merers <br />* il-fA_ fl feer fl merers <br />ll Yos El No <br />Check lha msasuromenl uoed; <br />ffi feel I meters <br />fl leet [] metors <br />436 r <br />were lalltudo and longllude ln $ecllon A provlded by a licensed land survoyor? [J yes I No <br />I Check hsre ll altaehrnenls and desoribe in the Gommenls area. <br />Copy all pagos of thls Elevalion Cerliticalo and all attachments lor ('l) communily official, (A) lnsumnco <br />Addrese: '1224 S. Pioneer Way <br />Clly: Moses <br />Company Name:Woslorn Paclfic Englneering & Survey, lnc. <br />Commenls <br />Emall:not <br />3 <br />Ext. <br />State; WA ZP Gode: 98837 <br />(Includlng source of convorslon faotor ln c2;lype of ogulpmenl and por G2.6; and of any aftaohmenls)lHeal Pump pad was measured at tho top wlth the bottom of the hoat purnp ralsed an addllional elghl lnchee wllh legs <br />englnoer,certlllaallonThls tols be sealedend asigned landby arohlteotor aulhorlzedsuruayoI,lawslele loby llonel€V€cerlllyInformallon.lhal lnformatlonthe thteoncefllfy Gartillcate Desl loef{orls lhar6ptoso/,fs my dalalnterpret undersland lhalavallable,anyfalseslalamonlbeorlinsmaybypunlshablaundorB8.Ulmplsonment Seo0on 1001Code, <br />Ceilifle/s Name: Rlck Sklnner Llcense Numbsr:43619 <br />Tllle: Professlonal Land <br />765-1023 <br />Dst€:Slgnaturo: <br />Telephone: <br />) <br />FEMA Form FF-206-FY-2?.-152 (formedy 086-0-33) (10[22)Page 3 of 19