NCC193071_Annual Fee Payment Record_20201222

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 12/7/2020 5:21:43 PM (Workflow Start Event)
Submit by Georgoulias, Bethany 12/22/2020 3:09:54 PM (Annual Fee Payment Verification for NCC193071-2020)
Notice of Termination approved on 12122.
• Georgoulias, Bethany reassigned the task to Georgoulias, Bethany 12/22/2020 11:35 AM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: January 18, 2021 5:00
PM 12/7/2020 5:21 PM

NORTH CAROLINA
Environmental Quvllty
Certificate of NCC193071
Coverage (COC) This is passed fromthe worldlow when the invoice is filed.
No.*
NC Reference COC NCG01-2019-3071
No.*
Permit Status: INACTIVE
Already Rescinded: 12/22/2020
This field appears if the permt has already been termnated.
WAIVE FEE? * r Yes, Payment Not Applicable
f No, Payment Still Applies
Project Name * Supremia Dentistry
Project Address* 1704 S Main St, Wake Forest, NC
Permittee * Windsor Contracting LLC
County Wake
Invoice No. NCC193071-2020
This is passed fromthe worldlow when the invoice is filed.
Annual Fee * $ 100.00
Invoice Date * 12/8/2020
This is passed fromthe worldlow when the invoice is filed.
Invoice Due Date* 1/8/2021
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 Payment 12/22/2020
Received* Or, if WAN®or NOT FECBV®, this is the date that status is recorded.
e Payme nt
Transaction
Number*
Check Number*
Fee Status* WAIVED

Legally Responsible William Seymour
Person (Orig.)
Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail * Opportunity to rrodify probleme-nail address or perrrittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail * Opportunity to correct probleme-msil address or site contact info
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 12/22/2020