NCC211970_Contact Update Record_20240327

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 3/27/2024 12:38:41 PM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC211970
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2021-1970
Original NOI No.* 48903
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Clayton Properties Group, Inc
Project Name Georgia's Landing
Address 2505 Simpkins Rd and 6104 Fayetteville Road, Garner, NC
County Wake
Latitude 35.6937
Longitude -78.6766
Date COC Issued* 04/01/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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? 0• No
0 Yes
Billing Email [e-mail]
Billing Telephone No. [phone]
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Adam Speiran
Individual(Previous)
First Name(New)* Shawn
Last Name(New)* Harling
NEW Legally Reflects any revisions above
Responsible Shawn Harling
Individual*

Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 2521 Schieffelin Road,Suite 116,Apex, NC
Address(Previous) 27502-4400
NEW Permittee Street Address
Mailing Address* 2521 Schieffelin Road
Address Line 2
Suite 116
City State/Province/Region
Apex NC
Postal/Zip Code Country
27502-4400 us
Permittee Street 2521 Schieffelin Road,Suite 116,Apex, NC
Address(Previous) 27502-4400
NEW Permittee Street Street Address
Address* 2521 Schieffelin Road
Address Line 2
Suite 116
City State/Province/Region
Apex NC
Postal/Zip Code Country
27502-4400 us
Change Requested Shawn Harling(Manager-Land Development Division)via Modification request
by:* submitted 3/22/2024.
Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 03/27/2024