NCC230570_MODIFICATION Supporting Doc (ADDRESS CORRECTION)_20230425

DATE: 4/3/2023 PERMITNUMBER:
TO: CHARLOTTE-MECKLENBURG CODE ENFORCEMENT
FROM: MECKLENBURG COUNTY GIS JURISDICTION: CHAR
Remarks:
06503621,22
PARCEL NUMBER
ASSIGNED STREET ADDRESS (ADDRESS OF RECORD)
3154 FREEDOM DR
EXISTING STREET ADDRESS (IF DIFFERENT FROM ASSIGNED)
PROJECT NAME (IF APPLICABLE)
Signed: A'1�4.4Zfi
Addressing Verification Form Disclaimer. Statement
The party indicated on this application shall be responsible for maintaining this .address
throughout the life of the project from plan submittal through final C/O. The contents of this
form reflect information provided by the party listed on this form.
Incorrect information may result in delay in getting final approval of permits and the. final C/O
Special Circumstances: If a temporary address is being verified for the purposes of
Plan Review, the responsible party will be required to obtain and submit a new form
verifying the permanent address prior to issuance of the permit.
Name (please print)
Company
Company Address
Telephone #
Signature
Date
Revised Oct-2005