NCC216991_Annual Fee Payment Record_20221205

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 11/29/2022 1:19:04 PM (Workflow Start Event)
Submit by Clark, Paul B 12/5/2022 10:30:53 PM (2022 Annual Fee Payment Verification for NCC216991-2022)
0 COC rescinded
• Clark, Paul B assigned the task to Clark, Paul B 12/5/2022 10:30 PM
• The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: January 10, 2023 5:00
PM 11/29/2022 1:19 PM

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NORTH CAROLINA
Envlrmmm(af Quafhy
Certificate of
NCC216991
Coverage (COC) No. *
This is passed from the workflow when the invoice is filed.
NC Reference COC
NCG01-2021-6991
No. *
Permit Status:
INACTIVE
Already Rescinded:
12/5/2022
This field appears if the permit has already been terminated.
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
WAIVE FEE? *
• Yes, Payment Not Applicable
No, Payment Still Applies
Project Name*
Pendleton
Project Address*
Country Club Rd. at Tiseland, Winston-Salem, INC
Permittee*
Trent Adams Properties
County
Forsyth
Invoice No.*
NCC216991-2022
This is passed from the workflow when the invoice is filed.
Annual Fee*
$ 100.00
Invoice Date*
12/1/2022
This is passed from the workflow when the invoice is filed.
Invoice Due Date*
1/1/2023
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.
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 12/5/2022
Received * Or, if WAIVED or NOT RECEIVED, this is the date that status is recorded.

ePayment
Transaction Number*
Check Number*
Fee Status* WAIVED
Legally Responsible Trent Adams
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 [e-mail]
(If available)
CONFIRM Billing E- [e-mail]
mail Opportunity to correct problem e-mail address or billing contact info
Billing Telephone No. 13363823076
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
[e-mail]
for 30-day Reminder
This is the email for the 30-day reminder if needed (passed from workflow).
Project Name for 30-
Pendleton
day Reminder
The project name is passed from workflow for the 30-day reminder
Permittee Name for
Trent Adams Properties
30-day Reminder
The permittee is passed from workflow for the 30-day reminder
County for 30-day
Forsyth
Reminder
The county is passed from workflow for the 30-day reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date* 12/5/2022