NCC200136_Billing Contact Update Record_20210224

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Georgoulias, Bethany 2/24/2021 7:45:26 AM (Contact Changes Submitted)

Certificate of NCC200136
Coverage (COC) Enter the Certificate of Coverage Ninber (use capital letters)
No.*
NC Reference No. NCG01-2020-0136
Original NOI No.* 20368
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new OOC required)
Lebanon Road, LLC
Project Name
Northeast Village - Phase I
Address
6817 Lebanon Road, Mebane, NC
County
Orange
Latitude
36.0000
Longitude
-79.0000
Date COC Issued*
01/31/2020
Prior Rescission
This field will populate only if COChas already been rescinded.
Date
Which Contacts
F Billing Only
Have Changed?*
f Legally Responsible Individual Only
f 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
NEW Billing Email
[e-mail]
Billing Telephone
No.
NEW Billing
[phone], ext. 3147
Telephone No.
(Cptional)
Change Requested
Lisa Blackwood via e-mail on 2/23/2021.
by: *
Include any additional correspondence records in the Fbpository CDC folder.
Additional Information
for this update to contact information:

Addional
Explanation
(Optional)
Date * 02/24/2021