NCC217169_Contact Update Record (Mailing Address)_20230106

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 1/6/2023 7:54:33 AM (Contact Changes Submitted)

Certificate of NCC217169
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2021-7169
Original NOI No.* 76506
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Dirt2Dreams, LLC
Project Name Amphitheater Road Project
Address 431 WEST FIRETOWER ROAD, Swansboro, NC
County Carteret
Latitude 34.7270
Longitude-77.1010
Date COC Issued * 01 /03/2022
Prior Rescission Date This field will populate only if COC has already been rescinded.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? • No
Yes
Billing Email [e-mail]
Billing Telephone No. [phone]
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible
Brian K. Byrd
Individual (Previous)
First Name (New) *
Brian K.
Last Name (New)*
Byrd
NEW Legally
Reflects any revisions above
Responsible
Brian K. Byrd
Individual*

Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing PO Box 4692, 0, Emerald Isle, NC 28594-
Address (Previous) 2747
NEW Permittee Street Address
Mailing Address* PO Box 782
Address Line 2
City
Swansboro
Postal / Zip Code
28584
State / Province / Region
NC
Country
US
Permittee Street 8921 Crew Drive, 0, Emerald Isle, NC 28594-
Address (Previous) 2747
NEW Permittee Street Street Address
Address* 2057 Highway 58
Address Line 2
City
State / Province / Region
Swansboro
NC
Postal / Zip Code
Country
28584
us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Jimmy Farrington
(Previous)
Site Contact Title Member
(Previous)
Organization
(Previous)
First Name (New)* Jimmy
Last Name (New)* Farrington
NEW Site Contact* Reflects any revisions above
Jimmy Farrington
NEW Site Contact Member
Title
NEW Organization This field is not required on the NOI form and may not pre -populate.

Site Contact Email [e-mail]
(Previous)
NEW Site Contact [e-mail]
Email*
Site Contact 252-723-0002
Telephone No.
(Previous)
NEW Site Contact 252-723-0002
Telephone No.*
Site Contact Mailing 8921 Crew Drive, 0, Emerald Isle, NC 28594-
Address (Previous) 2747
NEW Site Contact Street Address
Mailing Address* 8921 Crew Drive
Address Line 2
City
State / Province / Region
Emerald Isle
NC
Postal / Zip Code
Country
28594-2747
us
Change Requested Paula Sutton (Executive Assistant, Dirt2Dreams) via e-mail on 1/5/2023.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 01 /06/2023