NCC222956_Contact Update Record (Billing)_20230525

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 5/25/2023 10:50:53 AM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC222956
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2022-2956
Original NOI No.* 102256
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Clayton Properties Group Inc
Project Name Fowler Tract-Phase 1
Address 705 Doc Nichols Road, Durham, NC
County Durham
Latitude 35.9620
Longitude -78.7844
Date COC Issued* 08/18/2022
Prior Rescission Date This field will populate only if COC has already been rescinded.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]
NEW Billing Email [e-mail]
Billing Telephone No. 919-901-2595
NEW Billing [phone]
Telephone No. (Optional)
Change Requested Arnaldo(Naldo)Echevarria via email on 5/25/2023.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 05/25/2023