NCC211890_Contact Update Record_20210331

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Selkane, Aziza 3/31/2021 9:39:46 AM (Contact Changes Submitted)

Certificate of NCC211890
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2021-1890
Original NOI No.* 48660
Project information associated with this permit (cannot change):
Permittee Listed
Organizaiton cannot be changed (new OOC required)
WF/Lee Wake Forest Manager, LLC
Project Name
Holding Village - Multifamily
Address
0 Friendship Chapel Road, Wake Forest, NC
County
Wake
Latitude
35.9598
Longitude
-78.5093
Date COC Issued*
03/30/2021
Prior Rescission
This field will populate only if OOChas already been rescinded.
Date
Which Contacts
f Billing Only
Have Changed?*
r Legally Responsible Individual Only
r Site Contact Only
r BOTH Legally Responsible Individual and Site Contact
Has Billing Contact
Choose'Yes'torevise Billing Contact details.
Changed?
r No
r Yes
Billing Email
[e-mail]
Billing Telephone
919-360-4197
No.
Site Contact
(Previous)
Site Contact Title
(Previous)
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Tony Castillo
Vice President
Organization
(Previous)
HKJ Construction

First Name (New)* Rick
Last Name (New) * Crouch
NEW Site Contact* Reflects any revisions above
Rick Crouch
NEW Site Contact Director of Pre -Construction
Title
NEW Organization Crestline Construction LLC
This field is not required on the NDI form and may not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact [phone]
Telephone No.
(Previous)
NEW Site Contact 317-620-6500
Telephone No.*
Site Contact Mailing 1086 Classic Road, 0, Apex, NC 27539
Address (Previous)
NEW Site Contact
Mailing Address*
Street Address
3333 Founders Road
Address Line 2
Suite 200
Cty
Indianapolis
Fbstal / Zip Code
46268
State / Rovince / Fbgion
IN
Country
USA
Change Requested Nathan Bales
by: * Include any additional correspondence records in the Pepository CDC folder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date * 03/31 /2021