SW5190703_Form_(Application)_(Page _2_of_8)_20200421

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization:State of North Carolina / North Carolina Central University
Signing Official & Title:Zack Abegunrin, Associate Vice Chancellor for Facilities Management
b. Contact information for person listed in item 1a above:
Street Address:1801 Fayetteville Street
City:Durham State:NC Zip:27707
Mailing Address (if applicable):1801 Fayetteville Street
City:Durham State:NC Zip:27707
Phone: (919 ) 530-7403 Fax: ( )
Email:[e-mail]
Please check the appropriate box. The applicant listed above is:
® The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
❑ Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:
Signing Official & Title:
b. Contact information for person listed in item 2a above:
Street Address:
City:
Mailing Address (if applicable):
State: Zip:
City: State: Zip:
Phone: ( ) Fax: ( )
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:Corvias
Signing Official & Title:Casey Tones, Project Manager
b. Contact information for person listed in item 3a above:
Mailing Address:200 Regency Forest Drive
Phone: (703 ) 687-7160
Email:[e-mail]
State:NC
Fax: ( )
4. Local jurisdiction for building permits: State of North Carolina
Point of Contact:Terry Philli
Zip:27518
Phone #: (919 ) 807-4097
Form SWU-101 Version Oct. 31, 2013 Page 2 of 8