NCC223057_Contact Update Record_20240904

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 9/4/2024 10:48:42 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC223057
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2022-3057
Original NOI No.* 103120
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Wayne County Development Alliance, Inc.
Project Name Park East Pad Ready Site
Address Gateway Drive, Goldsboro, NC
County Wayne
Latitude 35.3706
Longitude -77.9241
Date COC Issued* 04/01/2024
Prior Rescission Date This field will populate only if COC has already been rescinded.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. 919-731-7700
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Mark Pope
Individual(Previous)
First Name(New)* Craig
Last Name(New)* Foucht

NEW Legally Reflects any revisions above
Responsible Craig Foucht
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 208 Malloy Street,0,Goldsboro, NC 27534-
Address(Previous) 4477
NEW Permittee Street Address
Mailing Address* P.O. Box 10397
Address Line 2
City State/Province/Region
Goldsboro NC
Postal/Zip Code Country
27532 us
Permittee Street 208 Malloy Street,0,Goldsboro, NC 27534-
Address(Previous) 4477
NEW Permittee Street Street Address
Address* 218 E.Walnut Street
Address Line 2
City State/Province/Region
Goldsboro NC
Postal/Zip Code Country
27530 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Mark Pope
(Previous)
Site Contact Title President
(Previous)
Organization Wayne County Development Alliance, Inc.
(Previous)
First Name(New)* Craig
Last Name(New)* Foucht
NEW Site Contact* Reflects any revisions above
Craig Foucht

NEW Site Contact President
Title
NEW Organization Wayne County Development Alliance, Inc.
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 919-731-7700
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 208 Malloy Street,0,Goldsboro, NC 27534-
Address(Previous) 4477
NEW Site Contact Street Address
Mailing Address* P.O. Box 10397
Address Line 2
City State/Province/Region
Goldsboro NC
Postal/Zip Code Country
27532 us
Change Requested Craig Foucht via email on 9/3/2024
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 09/04/2024