NCC201437_Contact Update Record (Site Contact)_20220401

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Selkane, Aziza 4/1/2022 1:43:24 PM (Contact Changes Submitted)

Certificate of NCC201437
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2020-1437
Original NOI No.* 24143
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Pulte Home Company, LLC
Project Name RiverLights AQ Phase 2 & 3
Address 4410 River Road, Wilmington, NC
County New Hanover
Latitude 34.1489
Longitude-77.9319
Date COC Issued * 04/13/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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
Billing Telephone No.
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Jamison Fair
(Previous)
Site Contact Title
(Previous)
Organization
(Previous)
First Name (New)* Jamison

Last Name (New)* Fair
NEW Site Contact* Reflects any revisions above
Jamison Fair
NEW Site Contact
Title
NEW Organization 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 [phone]
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 4136 Passerine Avenue, 0, Wilmington, NC
Address (Previous) 28412
NEW Site Contact Street Address
Mailing Address* 4136 Passerine Avenue
Address Line 2
City
State / Province / Region
Wilmington
NC
Postal / Zip Code
Country
28412
us
Change Requested Matthew Raines by email on 4/1/2022
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date * 04/01 /2022