NCC192686_Contact Update Record_20211129

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Selkane, Aziza 11/29/2021 4:23:43 PM (Contact Changes Submitted)

Certificate of NCC192686
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2019-2686
Original NOI No.* 18185
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Hutton Lexington NC ST, LLC
Project Name Lexington Car Wash
Address 150 Lowes Blvd, Lexington, NC
County Davidson
Latitude 35.7921
Longitude-80.2594
Date COC Issued* 11/13/2019
Prior Rescission Date This field will populate only if COC has already been rescinded.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.
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible
Karen Hutton
Individual (Previous)
First Name (New) *
Karen
Last Name (New)*
Hutton
NEW Legally
Reflects any revisions above
Responsible
Karen Hutton
Individual*

Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee 423-402-1993
Telephone No.*
Permittee Mailing 736 Cherry Street, 0, Chattanooga, TN
Address (Previous) 37402-1909
NEW Permittee Street Address
Mailing Address* 736 Cherry Street
Address Line 2
City
State / Province / Region
Chattanooga
TN
Postal / Zip Code
Country
37402-1909
us
Permittee Street 736 Cherry Street, 0, Chattanooga, TN
Address (Previous) 37402-1909
NEW Permittee Street Street Address
Address* 736 Cherry Street
Address Line 2
City
State / Province / Region
Chattanooga
TN
Postal / Zip Code
Country
37402-1909
us
Change Requested Teri Elliott by email on 11/29/2021
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 11 /29/2021