NCC191209_Contact Update Record (Billing Only)_20230316

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by bethany.georgoulias 3/16/2023 12:42:50 PM (Contact Changes Submitted)

Certificate of NCC191209
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2019-1209
Original NOI No.* 14470
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
CLINARD FARM PARTNERS, LLC
Project Name BRYSON PARK 4-5
Address HEGE ROAD. ARCADIA TOWNSHIP. NC
County Davidson
Latitude 35.9693
Longitude-80.2728
Date COC Issued * 08/09/2019
Prior Rescission Date This field will populate only if COC has already been rescinded.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?
Q No
0 Yes
Billing Email
[e-mail]
NEW Billing Email
[e-mail]
Billing Telephone No.
[phone]
NEW Billing
[phone]
Telephone No.
(Optional)
Change Requested
Jason Cheek via email on 3/16/2023.
by:*
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 03/16/2023