NCC200858_Contact Update Record_20210518

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Selkane, Aziza 5/18/2021 3:39:49 PM (Contact Changes Submitted)

Certificate of NCC200858
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2020-0858
Original NOI No.* 22672
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new OOC required)
Pulte Home Company, LLC
Project Name
RiverLights AQ Phase 2 & 3
Address
4410 River Road, Wilminton, NC
County
New Hanover
Latitude
34.1489
Longitude
-77.9319
Date COC Issued*
04/29/2020
Prior Rescission
This field will populate only if COChas already been rescinded.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
Billing Telephone
No.
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Jamison Fair
(Previous)
Site Contact Title
(Previous)
Organization
(Previous)

First Name (New)* Jamison
Last Name (New) * Fair
NEW Site Contact*
NEW Site Contact
Title
Peflects any revisions above
Jamison Fair
NEW Organization This field is not required on the N01 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
[phone]
Telephone No.*
Site Contact Mailing
4136 Passerine Avenue, 0, Wilmington, NC
Address (Previous)
28412
NEW Site Contact
Mailing Address*
Street Address
4136 Passerine Avenue
Address Line 2
City
Wilmington
Fbstal / Zip Code
28412
State / Rovince / Fbgion
NC
Country
us
Change Requested Jamison Fair
by: * Include any additional correspondence records in the Fbpository 00Cfolder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date * 05/18/2021