NCC203765_Contact Update Record_20210802

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Georgoulias, Bethany A 8/2/2021 7:15:58 AM (Contact Changes Submitted)

Certificate of NCC203765
Coverage (COC) Enter the Certificate of Coverage Ninber (Use capital letters)
No.*
NC Reference No. NCG01-2020-3765
Original NOI No.* 30547
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new OOC required)
Madison 29 Owner, LLC
Project Name
Hwy 29 Apartments
Address
12601 US 29 HY, Charlotte, NC
County
Mecklenburg
Latitude
35.3438
Longitude
-80.6997
Date COC Issued*
08/31/2020
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This field will populate only if COChas already been rescinded.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
NEW Billing Email [e-mail]
Billing Telephone
No.
NEW Billing [phone]
Telephone No. (Cptional)
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Jamie Cameron
(Previous)

Site Contact Title
(Previous)
Organization Madison 29 Owner, LLC
(Previous)
First Name (New)* Rebecca
Last Name (New) * Levell
NEW Site Contact*
NEW Site Contact
Title
Reflects any revisions above
Rebecca Levell
NEW Organization Madison Capital Group, LLC
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
7042750433
Telephone No.
(Previous)
NEW Site Contact
[phone]
Telephone No.*
Site Contact Mailing
6805 Morrison Boulevard, Suite 250,
Address (Previous)
Charlotte, NC 28211
NEW Site Contact
Street Address
Mailing Address*
6805 Morrison Boulevard
Address Line 2
Suite 250
City
State / Province / Region
Charlotte
NC
Rbstal / Zip Code
Country
28211
us
Change Requested Rebecca Levell via e-mail on 8/1/2021
by: * Include any additional correspondence records in the Repository 00Cfolder.
Additional Information for this update to contact information:
Addional
Explanation
(Optional)
Date *
08/02/2021