NCC191459_Contact Update Record_20201209

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Selkane, Aziza 12/9/2020 2:19:46 PM (Contact Changes Submitted)

Certificate of NCC191459
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2019-1459
Original NOI No.* 14987
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new OOC required)
City of Hickory
Project Name
NCDOT STBG-DA PROJECT EB-5939 RIVERWALK
Address
Old Lenoir Road, Hickory, NC
County
Burke
Latitude
35.7561
Longitude
-81.3751
Date COC Issued*
08/19/2019
Prior Rescission
This field will populate only if COChas already been rescinded.
Date
Which Contacts
r Legally Responsible Individual Only
Have Changed?*
f• Site Contact Only
r BOTH Legally Responsible Individual and Site Contact
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact
Kevin Greer
(Previous)
Site Contact Title
Public Services Director
(Previous)
Organization
City of Hickory
(Previous)
First Name (New)*
Shawn
Last Name (New)*
Pennell
NEW Site Contact *
Peflects any revisions above
Shawn Pennell
NEW Site Contact
Title

NEW Organization City of Hickory
This field is not required on the NCI form and nay not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 828-323-7550
Telephone No.
(Previous)
NEW Site Contact 828-323-7427
Telephone No.*
Site Contact Mailing 1441 9th Avenue, 0, Hickory, NC 28601
Address (Previous)
NEW Site Contact
Mailing Address*
Street Address
1441 9th Avenue
Address Line 2
city
Hickory
Fbstal / Zip Code
28601
State / Rovince / Fbgion
NC
Country
us
Change Requested Shaven Pennell
by: * Include any additional correspondence records in the Fbpository 00Cfolder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date * 12/09/2020