NCC205899_Contact Update Record (Legally Resp Change)_20220124

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 1/24/2022 7:54:17 AM (Contact Changes Submitted)

Certificate of NCC205899
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2020-5899
Original NOI No.* 39403
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Town of Hope Mills
Project Name John W. Hodges Public Safety Center
Address 5776 Rockfish Road, Hope Mills, NC
County Cumberland
Latitude 34.9730
Longitude-78.9590
Date COC Issued * 01 /05/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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? U No
Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Melissa Adams
Individual (Previous)
First Name (New)* Scott
Last Name (New) * Meszaros

NEW Legally Reflects any revisions above
Responsible Scott Meszaros
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 5770 Rockfish Road, 0, Hope Mills, NC
Address (Previous) 28348-1848
NEW Permittee Street Address
Mailing Address* 5770 Rockfish Road
Address Line 2
City
State / Province / Region
Hope Mills
NC
Postal / Zip Code
Country
28348-1848
us
Permittee Street 5770 Rockfish Road, 0, Hope Mills, NC
Address (Previous) 28348-1848
NEW Permittee Street Street Address
Address* 5770 Rockfish Road
Address Line 2
City
State / Province / Region
Hope Mills
NC
Postal / Zip Code
Country
28348-1848
us
Change Requested Scott Meszaros via Modification Request submitted 1/21/2022.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation Town Manager change
(Optional)
Date * 01 /24/2022