NCC201299_Contact Update Record_20210518

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Selkane, Aziza 5/18/2021 4:17:02 PM (Contact Changes Submitted)

Certificate of NCC201299
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2020-1299
Original NOI No.* 23785
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new OOC required)
City of Wilmington
Project Name Greenville -White Drainage Project
Address Greenville Ave, Wilmington, NC
County New Hanover
Latitude 34.2156
Longitude-77.8460
Date COC Issued* 04/27/2020
Prior Rescission This field will populate only if OOChas already been rescinded.
Date
Which Contacts f Billing Only
Have Changed?* f Legally Responsible Individual Only
f 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.
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Sterling Cheatham
Individual
(Previous)
First Name (New)* Sterling
Last Name (New) * Cheatham

NEW Legally Fbflects any revisions above
Responsible Sterling Cheatham
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee 9103415889
Telephone No.
(Previous)
NEW Permittee 9103415889
Telephone No.*
Permittee Mailing 212 Operations Center Drive, 0, Wilmington,
Address (Previous) NC 28412
NEW Permittee
Mailing Address*
Street Address
209 Coleman Dr
Address Line 2
City
Wilmington
Fbstal / Zip Code
28412
State / Rovince / Pegion
NC
Country
us
Permittee Street 212 Operations Center Drive, 0, Wilmington,
Address (Previous) NC 28412
NEW Permittee Street Address
Street Address* 209 Coleman Dr
Address Line 2
aty
State / Rovince / Region
Wilmington
NC
Fbstal / Zip Code
Country
28412
us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact
Anthony Geathers
(Previous)
Site Contact Title
Project Manager
(Previous)
Organization
City of Wilmington
(Previous)
First Name (New)*
Anthony
Last Name (New) *
Geathers
NEW Site Contact*
Reflects any revisions above
Anthony Geathers

NEW Site Contact Project Manager
Title
NEW Organization City of Wilmington
This field is not required on the NOI form and may not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 9103415889
Telephone No.
(Previous)
NEW Site Contact 9103415889
Telephone No.*
Site Contact Mailing 212 Operations Center Drive, 0, Wilmington,
Address (Previous) NC 28412
NEW Site Contact
Mailing Address*
Street Address
209 Coleman Dr
Address Line 2
City
Wilmington
Fbstal / Zip Code
28412
State / Rovince / Fbgion
NC
Country
us
Change Requested Diana Leonard
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