NCC190470_Contact Update Record (I)_20210601

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Georgoulias, Bethany A 6/l/2021 4:21:02 PM (Contact Changes Submitted)

Certificate of NCC1 90470
Coverage (COC) Enter the Certif icate of Coverage Ninber (Use capital letters)
No. *
NC Reference No. NCGOl-2019-0470
Original NOI No.* 11723
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new OOC required)
Doggett Road 41, LLC
Project Name
Doggett Road Subdivision
Address
7529 Doggett Road, Monroe To\&nship, NC
County
Guilford
Latitude
36.2111
Longitude
-79.7367
Date COC Issued *
06/04/2019
Prior Rescission
This field will populate only if 00C has already been rescinded.
Date
Which Contacts
r 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'to revise Billing ODntact details.
Changed?
r No
r Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone
No.
NEW Billing [phone]
Telephone No. (Cptional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Paul Holst
Individual
(Previous)

First Name (New)* Ashlee
Last Name (New) Cateni
NEW Legally Peflects any revisions above
Responsible Ashlee Cateni
Individual*
Permittee Email
(Previous)
NEW Permittee
Email*
Permittee
Telephone No.
(Previous)
NEW Permittee
Telephone No.*
Paul. [e-mail]
[e-mail]
[phone]
[phone]
Permittee Mailing 3514 Drawbridge Parkway, Suite B, 0,
Address (Previous) Greensboro, North Carolina 27410
NEW Permittee
Mailing Address*
Street Address
610 Pembroke Road
Address Line 2
10007
Cly
Greensboro
Fbstal / Zip Code
27408
Permittee Street 3514 Drawbridge Parkway, Suite B, 0,
Address (Previous) Greensboro, North Carolina 27410
NEW Permittee
Street Address
Street Address
610 Pembroke Road
Address Line 2
10007
city
Greensboro
Fbstal / Zip Gode
27408
State / Frovince / Fbgion
North Carolina
Country
United States
State / Frovince / Pbegion
North Carolina
Country
United States
Change Requested Ashlee Cateni via e-mail on 6/1/2021.
by: * Include any additional correspondence records in the Fbpository CDC folder.
Additional Information for this update to contact information:
Addional Paul Holst is no longer with the company.
Explanation
(Optional)
Date * 06/01/2021