NCC190053_Contact Update Record_20201218

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Selkane, Aziza 12/18/2020 4:19:08 PM (Contact Changes Submitted)

Certificate of NCC190053
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2019-0053
Original NOI No.* 10192
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new OOC required)
City of Hickory -Assistant City Manager
Project Name
Project Cure
Address
Startown Road, Hickory, NC
County
Catawba
Latitude
35.6842
Longitude
-81.2871
Date COC Issued*
04/17/2019
Prior Rescission
This field will populate only if COChas already been rescinded.
Date
Which Contacts
f Billing Only
Have Changed?*
r Legally Responsible Individual Only
r Site Contact Only
r BOTH Legally Responsible Individual and Site Contact
Has Billing Contact
Choose'Yes'torevise Billing Contact details.
Changed?
r No
r Yes
Billing Email
Billing Telephone
No.
Site Contact
(Previous)
Site Contact Title
(Previous)
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Kevin Greer
Public Works Director
Organization
(Previous)
City of Hickory

First Name (New)* Shawn
Last Name (New) * Pennell
NEW Site Contact* Reflects any revisions above
Shawn Pennell
NEW Site Contact Public Works Director
Title
NEW Organization City of Hickory
This field is not required on the NOI form and may not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 828-323-7500
Telephone No.
(Previous)
NEW Site Contact 828-323-7500
Telephone No.*
Site Contact Mailing 76 North Center Street, 0, Hickory, NC 28601
Address (Previous)
NEW Site Contact
Mailing Address*
Street Address
76 North Center Street
Address Line 2
Cty
Hickory
Fbstal / Zip Code
28601
State / Rovince / Fbgion
NC
Country
us
Change Requested Shawn Pennell
by: * Include any additional correspondence records in the Pepository 00Cfolder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date * 12/18/2020