SW1190801_Supplemental Info Review_8/27/2019

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Anonymous User 8/27/2019 10:34:31 AM (Supplemental Submittal)
Submit by McCoy, Suzanne 8/27/2019 11:45:54 AM (Supplemental Info Submittal)
• The task was assigned to McCoy, Suzanne 8/27/2019 10:34 AM

Submittal Dated: 8/27/2019
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are ansmred.
Existing Project Information:
Rease supply the perrrit nunber for this project.
D# * Permit Namber
SW 1190801
Ecanples: SWxxxxxxx, NOQaxxxx, or NOSxxxxxx
Facility Name:* Leicester Fire Station
County: Buncombe
Name: Jacob Grieb
Who is submitting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Qick the upload button or drag and drop files here to attach document
65X 0079 (Leicester VFD) - Draft Report - Proposed
Leicester Vol. Fire Stn., Alexander Road, Leicester, 3.38MB
NC).pdf
Warranty Deed.pdf 636.26KB
3827 SW REPORT.pdf 3.65MB
3827 FULL SET 8-13-19.pdf 17.15MB
Only pdf files are accepted.
Describe the attachments:
Per email dated 8/26/19 attached our documents originally provided per email.
* V By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
• I agree that submission of this Supplemental Information form is a "transaction" subject to Chapter 66, Article 40 of the
NC General Statutes (the "Uniform Electronic Transactions Act)
o I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Supplemental Information form."
Full Name:* Jacob Grieb

Signature:
Date Submitted: 8/27/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW 1190801
Who needs a d Central Office
copy?* r- Regional Office
Central Office Reviewer:*
Jim Farkas - eads\jjfarkas
Select Reviewing Office*
Asheville Regional Office — 828-296-4500
Select RO Reviewer:*
[e-mail]