NCC190042_Annual Fee Payment Record_20201028

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 10/20/2020 9:48:18 AM (Workflow Start Event)
Submit by Selkane, Aziza 10/28/2020 3:42:56 PM (Annual Fee Payment Verification for NCC190042-2020)
* Town of Lewisville
• Selkane, Aziza assigned the task to Selkane, Aziza 10/28/2020 3:42 PM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: December 1, 2020 5:00
PM 10/20/2020 9:48 AM

SfA7$ q,
NORTH CAROLINA
Envlrmmentuf Quuftty
Certificate of
NCC190042
Coverage (COC)
This is passed fromthe worKlow when the invoice is filed.
No. *
NC Reference COC
NCG01-2019-0042
No.*
Permit Status:
Active
Project Name *
U-5617 (Williams Road Gateway Project)
Project Address*
SR 1173 (Williams Road), Town of Lewisville, NC
Permittee *
Town of Lewisville
County
Forsyth
Invoice No.*
NCC190042-2020
This is passed fromthe worldlow when the invoice is filed.
Annual Fee *
$ 100.00
Invoice Date*
10/20/2020
This is passed fromthe worldlow when the invoice is filed.
Invoice Due Date *
11/20/2020
This is passed from the woMlow when the invoice is filed.
An automated email reminder is sent to the permittee when the invoice is due. Wait until invoice is 15 days overdue
before proceeding to a Notice of Deficiency.
Important: If you change the choice below to Payment NOT RECEIVED, the fee status becomes PAST DUE, and the
permittee will receive a Notice of Deficiency.
Annual Fee Payment r Fee Payment Received or Not Applicable.
Received* r Fee Payment NOT RECEIVED.
Date Payme nt 10/28/2020
Received * Or, if WAN® or NDT FCBV®, this is the date that status is recorded.
Method of Payment* r electronic
IT check
f other
Check Number* 31236
Fee Status* PAID
Legally Responsible William Perkins
Person (Orig.)

Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail * Opportunity to rrodify problem e-mail address or perrrittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail * Opportunity to correct problem e-mail address or site contact info
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 10/28/2020