NCC200004_Annual Fee Payment Record (2023 Fee)_20230202

Action History (UTC-05:00) Eastern Time (US & Canada)
by Workflow 12/27/2022 1:16:24 PM (Workflow Start Event)
Submit by Clark, Paul B 2/2/2023 9:36:54 PM (2023 Annual Fee Payment Verification for NCC200004-2023)
F COC rescincded
• Clark, Paul B assigned the task to Clark, Paul B 2/2/2023 9:36 PM
• The task was assigned to DEMLR NCG01 Annual Fee Team. The due date is: February 7, 2023 5:00
PM 12/27/2022 1:16 PM

STA—
NORTH CAROLINA
Enylrmme tal Quallty
Certificate of NCC200004
Coverage (COC) No. * This is passed from the workflow when the invoice is filed.
NC Reference COC NCG01-2020-0004
No.*
Permit Status: INACTIVE
Already Rescinded: 2/2/2023
This field appears if the permit has already been terminated.
Year COC Issued 2020
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
PAID
WAIVE FEE? *
Yes, Payment Not Applicable
No, Payment Still Applies
Project Name*
CHS Pineville Phase III Bed Tower (#401921)
Project Address * 10628 Park Road, Charlotte, NC
Permittee* Atrium Health
County Mecklenburg
Invoice No.* NCC200004-2023
This is passed from the workflow when the invoice is filed.
Annual Fee* $ 100.00
•
2022 Fee Status
PAID
Invoice Date* 1/1/2023
This is passed from the workflow when the invoice is filed.
Invoice Due Date* 2/1/2023
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.
Days Overdue 1
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 2/2/2023
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 Thomas Washington
Person (Orig.)
Permittee E-mail* [e-mail]
CONFIRM Permittee [e-mail]
E-mail * Opportunity to modify problem e-mail address or permittee contact info
Site Contact E-mail* [e-mail]
CONFIRM Site [e-mail]
Contact E-mail * Opportunity to correct problem e-mail address or site contact info
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-
CHS Pineville Phase III Bed Tower (#401921)
day Reminder
The project name is passed from workflow for the 30-day reminder
Permittee Name for
Atrium Health
30-day Reminder
The permittee is passed from workflow for the 30-day reminder
County for 30-day
Mecklenburg
Reminder
The county is passed from workflow for the 30-day reminder
Additional Billing Contact E-mails
Additional E-mail for
CC:
Review Date* 2/2/2023