NCC192869_Billing Contact Update Record_20220103

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 1/3/2022 1:10:17 PM (Contact Changes Submitted)

Certificate of NCC192869
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2019-2869
Original NOI No.* 18583
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Future Foam, Incorporated
Project Name Future Foam Building Expansion - Lot Grading
Address 1300 Prospect Street, High Point, NC
County Guilford
Latitude 35.9270
Longitude-80.0239
Date COC Issued * 12/02/2019
Prior Rescission Date This field will populate only if COC has already been rescinded.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? No
• Yes
Billing Email
NEW Billing Email
Billing Telephone No.
NEW Billing
Telephone No.
[e-mail]
[phone] ext 255
(Optional)
Change Requested Ann Besterci via e-mail on 1/3/2022
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation Invoice contact is in High Point, NC office rather than home office in Iowa.
(Optional)
Date * 01 /03/2022