NCC220172_Contact Update Record_20230608

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 6/8/2023 1:35:12 PM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC220172
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2022-0172
Original NOI No.* 77798
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Wake County Board of Education
Project Name Hilltop Needmore Road Elementary School
Address 4575 Hilltop Needmore Road, Fuquay-Varina, NC
County Wake
Latitude 35.6301
Longitude -78.7369
Date COC Issued* 01/26/2022
Prior Rescission Date This field will populate only if COC has already been rescinded.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? Q No
0 Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 919.694.7542
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Mark Strickland
Individual(Previous)
First Name(New)* Mark
Last Name(New)* Strickland

NEW Legally Reflects any revisions above
Responsible Mark Strickland
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 5625 Dillard Drive,Crossroad Building 1,
Address(Previous) Cary, NC 27518-9226
NEW Permittee Street Address
Mailing Address* 5625 Dillard Drive
Address Line 2
Crossroad Building 1
City State/Province/Region
Cary NC
Postal/Zip Code Country
27518-9226 us
Permittee Street 5625 Dillard Drive,Crossroad Building 1,
Address(Previous) Cary, NC 27518-9226
NEW Permittee Street Street Address
Address* 5625 Dillard Drive
Address Line 2
City State/Province/Region
Cary NC
Postal/Zip Code Country
27518-9226 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact William Hartley
(Previous)
Site Contact Title Director-Facilities Design and Construction
(Previous)
Organization Wake County Board of Education
(Previous)
First Name(New)* Brandon
Last Name(New)* Williams
NEW Site Contact* Reflects any revisions above
Brandon Williams

NEW Site Contact Director-Facilities Design and Construction
Title
NEW Organization Wake County Board of Education
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 919.588.3577
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 5625 Dillard Dr„0,Cary, NC 27518
Address(Previous)
NEW Site Contact Street Address
Mailing Address* 5625 Dillard Drive
Address Line 2
City State/Province/Region
Cary NC
Postal/Zip Code Country
27518-9226 us
Change Requested Mark Strickland via Modification Request submitted 6/7/2023.Owner email address
by:* corrected and Site Contact updated.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 06/08/2023