NCC216900_NOI 75496 Payment Verification_20211214

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 12/10/2021 3:42:22 PM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 12/13/2021 7:24:46 AM (Review - Construction NOI 75496)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 12/10/2021 3:42 PM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: December 14, 2021 5:00
PM 12/10/2021 3:42 PM
Submit by Evans, Shaundra M 12/14/2021 7:56:09 AM (Payment Verification for NCC216900)
F David L Forbis
• Evans, Shaundra M assigned the task to Evans, Shaundra M 12/14/2021 7:55 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: January 24, 2022 5:00 PM
12/13/2021 7:24 AM

5 A7
Payment •
NORTH CAROLINA
Envlrmmm(af Quafhy
Project Name
160 N Brackenfern Ln
Lot Numbers
(If listed on the eNOI)
170
NC Reference No.*
NCG01-2021-6900
Certificate of
NCC216900
Coverage (COC) No.*
Invoice Date
12/13/2021
Initial Invoice No.
NCC216900-2021
Initial Fee
$ 100.00
Invoice Due Date
1/12/2022
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*
• Payment Received.
Payment NOT RECEIVED.
Payment Status
PAID
Date Payment
12/14/2021
Received *
(Or, if not received, date rejected for no payment)
Method of Payment*
• electronic
check
Other
ePayment
607773092
Transaction Number*
NOI Tracking No.
75496
Tracking ID referenced upon submittal
This is an Express
• No
Review Project
Yes
Project Tracking ID
NCC-MOORE-2021-160 N Brackenfern Ln