NCC191961_Annual Fee Payment Record_20201208

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 11/16/2020 5:42:49 PM (Workflow Start Event)
Submit by Selkane, Aziza 12/8/2020 3:20:52 PM (Annual Fee Payment Verification for NCC191961-2020)
p Mungo Homes
Check is for $300 covering NCC192589, NCC191961, and NCC192603
• Selkane, Aziza assigned the task to Selkane, Aziza 12/8/2020 3:19 PM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: December 28, 2020 5:00
PM 11/16/2020 5:42 PM

SfA7$ q,
NORTH CAROLINA
Envlrmmentuf Quuftty
Certificate of
NCC191961
Coverage (COC)
This is passed fromthe worKlow when the invoice is filed.
No. *
NC Reference COC
NCG01-2019-1961
No.*
Permit Status:
Active
Project Name *
Camden Park Phase 2
Project Address*
Glenburn Drive, Winston-Salem, NC
Permittee *
Shugart Manageent, Inc.
County
Forsyth
Invoice No.*
NCC191961-2020
This is passed from the worldlow when the invoice is filed.
Annual Fee *
$ 100.00
Invoice Date*
11/17/2020
This is passed from the worldlow when the invoice is filed.
Invoice Due Date *
12/17/2020
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 12/8/2020
Received * Or, if WAIVBD or NDT FCBV®, this is the date that status is recorded.
Method of Payment* r electronic
r check
r other
Check Number* 37293
Fee Status* PAID
Legally Responsible Grover Shugart
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-rrail address or site contact info
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 12/8/2020