NCC216413_Contact Update Record_20240917

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 9/17/2024 4:05:52 PM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC216413
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2021-6413
Original NOI No.* 73138
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
D.R. Horton, Inc.
Project Name Tap Root-Phase 1A
Address 93 Tap Root Dairy Road, Hendersonville, NC
County Henderson
Latitude 35.4080
Longitude -82.5250
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Prior Rescission Date This field will populate only if COC has already been rescinded.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. 8645514643
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Brian Etheridge
Individual(Previous)
First Name(New)* Tracey
Last Name(New)* Davis

NEW Legally Reflects any revisions above
Responsible Tracey Davis
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 8001 Arrowridge Boulevard,0,Charlotte, NC
Address(Previous) 28273-5604
NEW Permittee Street Address
Mailing Address* 7208 Falls of Neuse Road
Address Line 2
Suite 201
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27615 us
Permittee Street 8001 Arrowridge Boulevard,0,Charlotte, NC
Address(Previous) 28273-5604
NEW Permittee Street Street Address
Address* 7208 Falls of Neuse Road
Address Line 2
Suite 201
City State/Province/Region
Raleigh NC
Postal/Zip Code Country
27615 us
Change Requested Tracey Davis via Modification request submitted 9/12/2024.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 09/17/2024