NCC215249_NOI 65019 Payment Verification_20210927

Action History (UTC-05:00) Eastern Time (US & Canada)
Subrrit by Anonymous User 9/16/2021 2:32:28 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 9/17/2021 7:39:57 AM (Review- Construction NOI 65019)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 9/16/2021 2:33 PM
The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: September 20, 2021 5:00
PM 9/16/2021 2:33 PM
Submit by Selkane, Aziza 9/27/2021 11:12:23 AM (Payment Verification for NCC215249)
* Pardee Ambulatory Surgery Center LLC
• Selkane, Aziza assigned the task to Selkane, Aziza 9/27/2021 11:11 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: October 29, 2021 5:00 PM
9/17/2021 7:40 AM

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VerificationPayrmnt
NORTH CAROLINA
Environmental Quvllly
Project Name
Pardee Partners ASC
Lot Numbers
(If listed on the eNOI)
NC Reference No.*
NCG01-2021-5249
Certificate of
NCC215249
Coverage (COC)
No.*
Invoice Date
9/17/2021
Initial Invoice No.
NCC215249-2021
Initial Fee
$ 100.00
Invoice Due Date
10/17/2021
Important: If you change
the choice below to Payment NOT RECEIVED, the application will be rejected, and a COC will
not be issued. This is the ONLY way to reject an eNOI at this step.
Payment Received* IT Payment Received.
f Payment NOT RECEIVED.
Payment Status
PAID
Date Payment
9/27/2021
Received*
(Or, if not received, date rejected for no payrrent)
Method of Payment*
r electronic
IT check
f Other
Check Number*
1020
NOI Tracking No.
65019
Tracking ID referenced upon subrrittal
This is an Express
IT No
Review Project
r Yes
Project Tracking ID
NCC-HENDE-2021-Pardee Partners ASC