SW6230704_Application Form_20231020

III. CONTACT INFORMATION
1 ,i.Print Applicant/Signing Official's name and title (specifically the developer,property owner,lessee,
designated government official,individual,etc.who owns the project):
Applicant/Organization:Matamv Homes,LLC
Signing Official&Title:Toe Conlan,Vice President
b.Contact information for person listed in item la above:
Street Address:11000 Regency Parkway,Suite 110
City:Cary State:NC Zip:27518
Mailing Address(if applicable):
City: State: Zip:
Phone: (269 ) 547-3807 Fax: ( )
Email:[e-mail]
c.Please check the appropriate box.The applicant listed above is:
®The property owner(Skip to Contact Information,item 3a)
0 Lessee*(Attach a copy of the lease agreement and complete Contact Information,item 2a and 2b below)
❑Purchaser*(Attach a copy of the pending sales agreement and complete Contact Information,item 2a and
2b below)
❑Developer*(Complete Contact Information,item 2a and 2b below.)
2.a.Print Property Owner's name and title below, if you are the lessee,purchaser or developer. (This is the
person who owns the property that the project is located on):
Property Owner/Organization:
Signing Official &Title:
b.Contact information for person listed in item 2a above:
Street Address:
City: State: _ Zip:
Mailing Address (if applicable):
City: State: Zip:
Phone: ( ) Fax: ( )
Email:
a. (Optional)Print the name and title of another contact such as the project's construction supervisor or other
person who can answer questions about the project:
Other Contact Person/Organization:
Signing Official&Title:
b.Contact information for person listed in item 3a above:
Mailing Address:
City: State: Zip:
Phone: ( ) Fax: { )
Email:
4. Local jurisdiction for building permits: I[arnett County
nt of Contact:Brad Sutton Phone#: (910 ) 893-7525
Form SWU-101 Version Oct.31,2013 Page 2 of6