NCC216257_Contact Update Record (Site Contact)_20230320

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by bethany.georgoulias 3/20/2023 11:31:54 AM (Contact Changes Submitted)

Certificate of NCC216257
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2021-6257
Original NOI No.* 72672
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Leoterra New Garden, LLC
Project Name New Garden Storage
Address 5598 Garden Village Way, Greensboro, NC
County Guilford
Latitude 36.1118
Longitude-79.9086
Date COC Issued* 11/10/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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
n Yes
Billing Email
[e-mail]
NEW Billing Email
[e-mail]
Billing Telephone No.
3364863653
NEW Billing
[phone]
Telephone No.
(Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Buddy Lyons
Individual (Previous)
First Name (New)* Buddy
Last Name (New) * Lyons

NEW Legally Reflects any revisions above
Responsible Buddy Lyons
Individual*
Permittee Email
[e-mail]
(Previous)
NEW Permittee
[e-mail]
Email*
Permittee Telephone
3364863653
No. (Previous)
NEW Permittee
3364863653
Telephone No.*
Permittee Mailing 110 A Shield Park Rd, 0, Kernersville, NC
Address (Previous) 27284
NEW Permittee Street Address
Mailing Address* 110 A Shield Park Rd
Address Line 2
City
State / Province / Region
Kernersville
NC
Postal / Zip Code
Country
27284
USA
Permittee Street 110 A Shield Park Rd, 0, Kernersville, NC
Address (Previous) 27284
NEW Permittee Street Street Address
Address * 110 A Shield Park Rd
Address Line 2
City State / Province / Region
Kernersville NC
Postal / Zip Code Country
27284 USA
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Kye Bunker
(Previous)
Site Contact Title Contractor
(Previous)
Organization Leoterra Development Inc
(Previous)
First Name (New)* Kat
Last Name (New) * Lyons
NEW Site Contact* Reflects any revisions above
Kat Lyons

NEW Site Contact Senior Director of Entitlements
Title
NEW Organization LeoTerra Development Inc.
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 3364863653
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 113 A Shields Park Drive, 0, Kernersville, NC
Address (Previous) 27284
NEW Site Contact Street Address
Mailing Address* 113 A Shields Park Drive
Address Line 2
City
State / Province / Region
Kernersville
NC
Postal / Zip Code
Country
27284
USA
Change Requested Jason Cheek via email requesting site contact updates on 3/10/2023.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 03/20/2023