NCC204072_Contact Update Record_20211019

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Selkane, Aziza 10/19/2021 9:08:50 AM (Contact Changes Submitted)

Certificate of
NCC204072
Coverage (COC) No.*
Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No.
NCG01-2020-4072
Original NOI No.*
31395
Project information associated with this permit (cannot change):
Permittee Listed
Organizaiton cannot be changed (new COC required)
Wake County Board of Education
Project Name
Fuller Elementary School
Address
806 Calloway Drive, Raleigh, NC
County
Wake
Latitude
35.7500
Longitude
-78.6200
Date COC Issued *
09/18/2020
Prior Rescission Date
This field will populate only if COC has already been rescinded.
Which Contacts Have
Billing Only
Changed?*
Legally Responsible Individual Only
Site Contact Only
BOTH Legally Responsible Individual and Site Contact
Has Billing Contact
Choose'Yes' to revise Billing Contact details.
Changed?
No
Yes
Billing Email
Billing Telephone No.
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Jason Reynolds
(Previous)
Site Contact Title Senior Project Manager
(Previous)
Organization WCPSS FD&C
(Previous)
First Name (New)* Marky

Last Name (New) * Liles
NEW Site Contact* Reflects any revisions above
Marky Liles
NEW Site Contact Senior Project Manager
Title
NEW Organization WCPSS FD&C
This field is not required on the NOI form and may not pre -populate.
Site Contact Email [e-mail]
(Previous)
NEW Site Contact
Email*
Site Contact
Telephone No.
(Previous)
[e-mail]
919-588-3581
NEW Site Contact 919-614-9502
Telephone No.*
Site Contact Mailing 111 Corning Road, Suite 190, Cary, NC
Address (Previous) 27518
NEW Site Contact Street Address
Mailing Address* 111 Corning Road
Address Line 2
Suite 190
City
Cary
Postal / Zip Code
27518
State / Province / Region
NC
Country
us
Change Requested Marky Liles by email on 10/19/2021
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 10/19/2021