NCC216851_Contact Update Record (Legally Resp)_20220119

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 1/19/2022 8:00:46 PM (Contact Changes Submitted)

Certificate of
NCC216851
Coverage (COC) No.*
Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No.
NCG01-2021-6851
Original NOI No.*
75323
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Gardner -Lee Properties III, LLC
Project Name Gardner -Lee Residence
Address 4613 Friends School Road, Durham, NC
County Orange
Latitude 36.0130
Longitude-79.0240
Date COC Issued * 12/10/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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? U No
Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. 919-730-8520
NEW Billing [phone]
Telephone No. (Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Lucy Stokes
Individual (Previous)
First Name (New)* John Alston
Last Name (New)* Gardner

NEW Legally Reflects any revisions above
Responsible John Alston Gardner
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No. (Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing PO Box 216, 0, Durham, NC 27701-3205
Address (Previous)
NEW Permittee Street Address
Mailing Address* 623 E. Franklin Street
Address Line 2
City
Chapel Hill
Postal / Zip Code
27514
Permittee Street 101 West Chapel Hill Street, 0, Durham, NC
Address (Previous) 27701-3205
State / Province / Region
NC
Country
USA
NEW Permittee Street Street Address
Address* 623 E. Franklin Street
Address Line 2
City
State / Province / Region
Chapel Hill
NC
Postal / Zip Code
Country
27514
USA
Change Requested Legally Responsible Individual Change form submitted 1/17/2022.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation DEMLR advised correction to legally responsible person on 1/4/2022 because
(Optional) original signee did not meet requirements. Changed to Managing Member of
Gardner -Lee Properties III, LLC.
Date * 01 /19/2022