NCC203615_Contact Update Record (Site Contact Email)_20230329

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 3/29/2023 8:25:54 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC203615
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2020-3615
Original NOI No.* 30084
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Calabash Station, LLC
Project Name Calabash Station
Address Calabash Road NW,Calabash, NC
County Brunswick
Latitude 33.9207
Longitude -78.5994
Date COC Issued* 08/20/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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? 0• No
0 Yes
Billing Email [e-mail]
Billing Telephone No. [phone]
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Bryant Spencer
(Previous)
Site Contact Title Director of Land Development
(Previous)
Organization Calabash Station, LLC
(Previous)
First Name(New)* Bryant

Last Name(New)* Spencer
NEW Site Contact* Reflects any revisions above
Bryant Spencer
NEW Site Contact Director of Land Development
Title
NEW Organization Calabash Station, LLC
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 [phone]
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 2919 Breezewood Avenue,Suite 100,0,
Address(Previous) Fayetteville, NC 28303-5283
NEW Site Contact Street Address
Mailing Address* 2919 Breezewood Avenue
Address Line 2
Suite 100
City State/Province/Region
Fayetteville NC
Postal/Zip Code Country
28303-5283 us
Change Requested David Vannoy via email on 3/29/2023(update to site contact email only).
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 03/29/2023