NCC233302_Contact Update Record_20241113

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Tev.Holloman 11/13/2024 8:53:47 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC233302
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2023-3302
Original NOI No.* 167499
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Refuel Operating Company
Project Name Refuel Market-Riverlights
Address 505 ARNOLD RD,Wilmington, NC
County New Hanover
Latitude 34.1340
Longitude -77.9200
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Prior Rescission Date This field will populate only if COC has already been rescinded.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
Yes
Billing Email [e-mail]
Billing Telephone No. 5405335093
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Ryan Robinson
(Previous)
Site Contact Title Sr Manager-Construction&Development
(Previous)
Organization Refuel Market
(Previous)
First Name(New)* Ashley

Last Name(New)* Todd
NEW Site Contact* Reflects any revisions above
Ashley Todd
NEW Site Contact Store Development Manager
Title
NEW Organization Refuel Market
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 8653379372
Telephone No.
(Previous)
NEW Site Contact 910-286-7568
Telephone No.*
Site Contact Mailing 4105 Faber Place Drive,suite 300,0, North
Address(Previous) Charleston,SC 29405
NEW Site Contact Street Address
Mailing Address* 4105 Faber Place Drive,suite 300
Address Line 2
City State/Province/Region
North Charleston SC
Postal/Zip Code Country
29405 United States
Change Requested Anita Harris, Paralegal,via email on 11/12/24
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 11/13/2024