NCC221428_NOI 86864 Payment Verification_20220412

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 4/11/2022 9:53:42 AM (NCG01 NOI Submission)
Approve by Broussard, Brooklyn C 4/11/2022 10:01:42 AM (Review - NOI 86864 Take 5 Car Wash)
• The task was assigned to Broussard, Brooklyn C by round robin distribution 4/11/2022 9:54 AM
• The task was assigned to DEMLR NCG01 NOI Review Team. The due date is: April 14, 2022 5:00 PM
4/11/2022 9:54 AM
by Workflow 4/11/2022 10:01:50 AM (Workflow Start Event)
Submit by Selkane, Aziza 4/12/2022 9:51:48 AM (Payment Verification for NCC221428)
F Justin Brown
• Selkane, Aziza assigned the task to Selkane, Aziza 4/12/2022 9:51 AM
The task was assigned to DEMLR NCG01 Payment Team. The due date is: May 23, 2022 5:00 PM
4/11/2022 10:01 AM

5 A7
Payment •
NORTH CAROLINA
Envlrmmm(af Quafhy
Project Name
Take 5 Car Wash
Lot Numbers
(If listed on the eNOI)
Lot 1 and 2
NC Reference No.*
NCG01-2022-1428
Certificate of
NCC221428
Coverage (COC) No.*
Invoice Date
4/11/2022
Initial Invoice No.
NCC221428-2022
Initial Fee
$ 100.00
Invoice Due Date
5/11/2022
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
4/12/2022
Received *
(Or, if not received, date rejected for no payment)
Method of Payment*
• electronic
check
Other
ePayment
627811412
Transaction Number*
NOI Tracking No.
86864
Tracking ID referenced upon submittal
This is an Express
• No
Review Project
Yes
Project Tracking ID
NCC-FORSY-2022-Take 5 Car Wash