NCC231157_Contact Update Record_20230424

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 4/24/2023 7:26:28 PM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC231157
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2023-1157
Original NOI No.* 136973
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
LeoTerra Graham, LLC
Project Name Lacy Farm-Phases 2 and 3
Address 1958 Lacy Holt Road,GRAHAM, NC
County Alamance
Latitude 36.0355
Longitude -79.4212
Date COC Issued* 04/20/2023
Prior Rescission Date This field will populate only if COC has already been rescinded.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? Q No
C) Yes
Billing Email [e-mail]
Billing Telephone No. 336.279.7280
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Clay Mize
(Previous)
Site Contact Title Construction Manager
(Previous)
Organization LeoTerra Development
(Previous)
First Name(New)* Kat

Last Name(New)* Lyons
NEW Site Contact* Reflects any revisions above
Kat Lyons
NEW Site Contact Senior Director of Entitlements
Title
NEW Organization LeoTerra Development
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 336.971.3574
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 110-A Shields Drive, 0, Kernersville, NC
Address(Previous) 27284
NEW Site Contact Street Address
Mailing Address* 110-A Shields Drive
Address Line 2
City State/Province/Region
Kernersville NC
Postal/Zip Code Country
27284 USA
Change Requested Jason Cheek via e-mail on 4/24/2023.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 04/24/2023