NCC221059_Contact Update Record (Physical Address)_20230306

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by bethany.georgoulias 3/6/2023 9:51:29 AM (Contact Changes Submitted)

Certificate of NCC221059
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2022-1059
Original NOI No.* 84064
Project information associated with this permit (cannot change):
Permittee Listed
Organizaiton cannot be changed (new COC required)
The Trustees of Wake Technical Community College
Project Name
Wake Technical Community College - Public Safety Simulation Complex
Address
5401 Rolesville Road, Wendell, NC
County
Wake
Latitude
35.8065
Longitude-78.4180
Date COC Issued* 03/15/2022
Prior Rescission Date This field will populate only if COC has already been rescinded.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? OQ No
0 Yes
Billing Email [e-mail]
Billing Telephone No. [phone]
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Jeffrey Carter
Individual (Previous)
First Name (New) * Jeffrey
Last Name (New) * Carter
NEW Legally Reflects any revisions above
Responsible Jeffrey Carter
Individual*

Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee 919-866-5148
Telephone No.*
Permittee Mailing 9101 Fayetteville Road, 0, Raleigh, NC
Address (Previous) 27603-5655
NEW Permittee Street Address
Mailing Address* 9101 Fayetteville Road
Address Line 2
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27603-5655
us
Permittee Street 9101 Fayetteville Road, 0, Raleigh, NC
Address (Previous) 27603-5655
NEW Permittee Street Street Address
Address * 4723 Advantage Way
Address Line 2
Building T
City
State / Province / Region
Raleigh
NC
Postal / Zip Code
Country
27603
us
Change Requested Deborah Hutchins via e-mail on 3/3/2023 (physical address update only).
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 03/06/2023