SW5220101_Application Form_20220124 (2)

III. CONTACT INFORMATION
1. a. Print Applicant / Signing Official's name and title (specifically the developer, property owner, lessee,
designated government official, individual, etc. who owns the project):
Applicant/Organization: Boddie-Enterpeise, Inc
Signing Official & Title:William R. Barnacascal, Jr. Vice President Restaurant Development
b.Contact information for person listed in item 1a above:
Street Address:1201 Noell Lane
City:Rocky Mount
State:NC
Zip:27804
Mailing Address (if applicablc):PO Box 1908
City:Rocky Mount State:NC Zip:27804-1801
Phone: (252 ) 937-2800 x 1301
Email:[e-mail]
Fax:
Please check the appropriate box. The applicant listed above is:
❑ The property owner (Skip to Contact Information, item 3a)
❑ Lessee* (Attach a copy of the lease agreement and complete Contact Information, item 2a and 2b below)
® Purchaser* (Attach a copy of the pending sales agreement and complete Contact Information, item 2a and
2b below)
❑ Developer* (Complete Contact Information, item 2a and 2b below.)
2. a. Print Property Owner's name and title below, if you are the lessee, purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization: Charles I. Floyd and wife, Sue I. Floyd
Signing Official & Title:Sue Floyd, owner
b.Contact information for person listed in item 2a above:
Street Address:2350 Hivhwav 98 West
City:Louisburgt
State:NC
Zip:27549
Mailing Address (if applicablc):2350 Highway 98 West
City:Louisburg State:NC Zip:27549
Phone: (919 ) 880-6620 (Sue) Fax: (na
Email:[e-mail]
3. a. (Optional) Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization: McAdams
Signing Official & Title:Ray Watson, PE
b.Contact information for person listed in item 3a above:
Mailing Address:2905 Meridian Parkway
City:Durham
State:NC
Phone: (919 ) 361-5000 Fax:
Email:[e-mail]
Zip:27713
4. Local jurisdiction for building permits: Town of Bunn
Point of ContactTrank Frazier Phone #: (252 ) 436-2040
Form SWU-101 Version Oct. 31, 2013 Page 2 of 6