NCC220587_Contact Update Record_20240403

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Tev.Holloman 4/3/2024 3:27:41 PM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC220587
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2022-0587
Original NOI No.* 79559
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Parathazathel Mohanan
Project Name Union Church Road Subdivision
Address Union Church Road, Ironton, NC
County Lincoln
Latitude 35.5320
Longitude -81.1630
Date COC Issued* 02/11/2022
Prior Rescission Date This field will populate only if COC has already been rescinded.
Which Contacts Have Billing Only
Changed?* Legally Responsible Individual Only
Site Contact Only
BOTH Legally Responsible Individual and Site Contact
Has Billing Contact Choose'Yes'to revise Billing Contact details.
Changed? Q No
0 Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 704-910-9170
NEW Billing 443-691-2290
Telephone No. (Optional)
Change Requested Tracy Mccullom,co owner,via email on 4/1/2024
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 04/03/2024