NCC192342_Contact Update Record (Legally Resp Change)_20230202

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by bethany.georgoulias 2/2/2023 1:27:49 PM (Contact Changes Submitted)

Certificate of NCC192342
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2019-2342
Original NOI No.* 17142
Project information associated with this permit (cannot change):
Permittee Listed
Organizaiton cannot be changed (new COC required)
Forestar Real Estate Group
Project Name
Brightwood Farm Phase 5
Address
Brightwood Farms Parkway, Whitsett, NC
County
Guilford
Latitude
36.0707
Longitude-79.5879
Date COC Issued * 10/29/2019
Prior Rescission Date This field will populate only if COC has already been rescinded.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? U No
Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Mallie Colavita
Individual (Previous)
First Name (New)* Jason
Last Name (New) * Rivenbark

NEW Legally Reflects any revisions above
Responsible Jason Rivenbark
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 4008 Mendenhall Oaks Parkway, Suite 101,
Address (Previous) High Point, NC 27265
NEW Permittee Street Address
Mailing Address* 8041 Arco Corporate Drive
Address Line 2
Suite 110
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27617
us
Permittee Street 4008 Mendenhall Oaks Parkway, Suite 101,
Address (Previous) High Point, NC 27265
NEW Permittee Street Street Address
Address* 8041 Arco Corporate Drive
Address Line 2
Suite 110
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27617
us
Change Requested Jason Rivenbark (VP of Real Estate Investments & Development) via Modification
by: request submitted 1/31/2023.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 02/02/2023