NCC203033_Annual Fee Payment Record_20210803

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 6/30/2021 7:22:34 AM (Workflow Start Event)
Submit by Selkane, Aziza 8/3/2021 12:34:10 PM (2021 Annual Fee Payment Verification for NCC203033-2021)
* Jay Oglesby
• Selkane, Aziza assigned the task to Selkane, Aziza 8/3/2021 12:33 PM
The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: August 11, 2021 5:00
PM 6/30/2021 7:22 AM

NORTH CAROLINA
Environmental Quvllty
Certificate of NCC203033
Coverage (COC) This is passed fromthe worldlow when the invoice is filed.
No.*
NC Reference COC NCG01-2020-3033
No.*
Permit Status: Active
Year COC Issued
2020
This field will be hidden.
2020 Fee Status
Check last year's fee status
Project Name*
The Gallery at Royal Park
Project Address*
4101 Glenloch Circle, Matthews, NC
Permittee *
Liberty Healthcare Properties of North Carolina, LLC
County Mecklenburg
Invoice No.* NCC203033-2021
This is passed fromthe workflow when the invoice is filed.
Annual Fee * $ 100.00
Invoice Date* 7/1/2021
This is passed from the workflow when the invoice is filed.
Invoice Due Date* 8/1/2021
This is passed from thew orkflow when the invoice is filed.
An automated email reminder is sent to the permittee when the invoice is due. Wait until invoice is 15 days overdue
before proceeding to a Notice of Deficiency.
Days Overdue 2
Wait at least 15 days until proceeding to NOD.
Important: If you change the choice below to Payment NOT RECEIVED, the fee status becomes PAST DUE, and the
permittee will receive a Notice of Deficiency.
Annual Fee Payment r Fee Payment Received or Not Applicable.
Received* r Fee Payment NOT RECEIVED.
Date Payment 8/3/2021
Received* Or, if WAN®or NOT FECBV®, this is the date that status is recorded.
Method of Payment* r electronic
f check
f other

ePayment 585552724
Transaction
Number*
Fee Status* PAID
Legally Responsible William Purvis
Person (Orig.)
Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail * Opportunity to rrodify problem e-mail address or perrrittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail * Opportunity to correct probleme-Trail address or site contact info
Original Billing E- (If available)
mail
CONFIRM Billing E- Opportunity to correct problem e-mail address or billing contact info
mail
Billing Telephone
No.
Permittee Email for [e-mail]
30-day Reminder This is the errail for the 3t}day rerrinder if needed (passed fromworldlow).
Site Contact Email [e-mail]
for 30-day Reminder This is the errail for the 30-day rerrinder if needed (passed fromworldlow)
Billing Contact Email This is theerrail for the 30-day rerrinder if needed (passed fromworldlow).
for 30-day Reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 8/3/2021