NCC210062_Annual Fee Payment Record_20220208

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 12/30/2021 10:09:47 PM (Workflow Start Event)
Submit by Morman, Alaina 2/8/2022 11:22:38 AM (2022 Annual Fee Payment Verification for NCC210062-2022)
0 Jeannette Lucas
• Morman, Alaina assigned the task to Morman, Alaina 2/8/2022 11:22 AM
• The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: February 10, 2022 5:00
PM 12/30/2021 10:09 PM

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Certificate of NCC210062
Coverage (COC) No. * This is passed from the workflow when the invoice is filed.
NC Reference COC NCG01-2021-0062
No. *
Permit Status: Active
Year COC Issued 2021
This field will be hidden.
Check previous years for outstanding fees (years that do not apply will be blank):
2020 Fee Status
2021 Fee Status
Project Name* Sam's Xpress Car Wash
Project Address* 110 & 124 Crenshaw Corners Drive, Wake Forest, NC
Permittee* SXCW Properties II, LLC
County Wake
Invoice No.* NCC210062-2022
This is passed from the workflow when the invoice is filed.
Annual Fee* $ 100.00
Invoice Date* 1/3/2022
This is passed from the workflow when the invoice is filed.
Invoice Due Date* 2/3/2022
This is passed from the workflow when the invoice is filed.
An automated email reminder is sent to the permittee when the invoice is due. Wait until invoice is 15 days overdue
before proceeding to a Notice of Deficiency.
Days Overdue 5
Wait at least 15 days until proceeding to NOD.
Important: If you change the choice below to Payment NOT RECEIVED, the fee status becomes PAST DUE, and the
permittee will receive a Notice of Deficiency.
Annual Fee Payment • Fee Payment Received or Not Applicable.
Received* Fee Payment NOT RECEIVED.
Date Payment 2/8/2022
Received * Or, if WAIVED or NOT RECEIVED, this is the date that status is recorded.

Method of Payment* electronic
check
other
ePayment 617159641
Transaction Number*
Fee Status* PAID
Legally Responsible Sami Nafisi
Person (Orig.)
Original Permittee E- [e-mail]
mail *
CONFIRM Permittee [e-mail]
E-mail * Opportunity to modify problem e-mail address or permittee contact info
Original Site Contact [e-mail]
E-mail *
CONFIRM Site [e-mail]
Contact E-mail* Opportunity to correct problem e-mail address or site contact info
Original Billing E-mail (If available)
CONFIRM Billing E- Opportunity to correct problem e-mail address or billing contact info
mail
Billing Telephone No.
Permittee Email for [e-mail]
30-day Reminder This is the email for the 30-day reminder if needed (passed from workflow).
Site Contact Email for [e-mail]
30-day Reminder This is the email for the 30-day reminder if needed (passed from workflow)
Billing Contact Email
This is the email for the 30-day reminder if needed (passed from workflow).
for 30-day Reminder
Project Name for 30-
Sam's Xpress Car Wash
day Reminder
The project name is passed from workflow for the 30-day reminder
Permittee Name for
SXCW Properties II, LLC
30-day Reminder
The permittee is passed from workflow for the 30-day reminder
County for 30-day
Wake
Reminder
The county is passed from workflow for the 30-day reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date * 2/8/2022