NCC193305_Contact Update Record (Legally Resp Change)_20230424

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 4/24/2023 7:40:21 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC193305
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2019-3305
Original NOI No.* 19795
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
The Nash County
Project Name Middlesex Corporate Centre Infrastructure Improvements
Address Middlesex Corporate Parkway&U.S.264 Alt., Middlesex, NC
County Nash
Latitude 35.7959
Longitude -78.1918
Date COC Issued* 12/27/2019
Prior Rescission Date This field will populate only if COC has already been rescinded.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
Yes
Billing Email
NEW Billing Email [e-mail]
Billing Telephone No.
NEW Billing [phone]
Telephone No. (optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Zee Lamb
Individual(Previous)
First Name(New)* Stacie
Last Name(New)* Shatzer

NEW Legally Reflects any revisions above
Responsible Stacie Shatzer
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 120 W.Washington Street,Suite 2004,
Address(Previous) Nashville, NC 27856
NEW Permittee Street Address
Mailing Address* 120 W.Washington Street
Address Line 2
Suite 3072
City State/Province/Region
Nashville NC
Postal/Zip Code Country
27856 United States
Permittee Street 120 W.Washington Street,Suite 2004,
Address(Previous) Nashville, NC 27856
NEW Permittee Street Street Address
Address* 120 W.Washington Street
Address Line 2
Suite 3072
City State/Province/Region
Nashville NC
Postal/Zip Code Country
27856 United States
Change Requested Stacie Shatzer(new County Manager)via Modification request submitted 4/21/2023.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 04/24/2023