NCC217007_Contact Update Record (Leg Resp Change)_20220413

Action History (UTC-05:00) Eastern Time (US & Canada)
Submit by Georgoulias, Bethany A 4/13/2022 7:42:43 AM (Contact Changes Submitted)

Certificate of NCC217007
Coverage (COC) No.* Enter the Certificate of Coverage Number (Use capital letters)
NC Reference No. NCG01-2021-7007
Original NOI No.* 75892
Project information associated with this permit (cannot change):
Permittee Listed Organizaiton cannot be changed (new COC required)
Davidson County Airport Authority
Project Name DCAA - Hangar & Taxilane Expansion
Address 1673 Aviation Way, Lexington, NC
County Davidson
Latitude 35.7798
Longitude-80.3008
Date COC Issued * 12/17/2021
Prior Rescission Date This field will populate only if COC has already been rescinded.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.
336-956-7774
NEW Billing
[phone]
Telephone No.
(Optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible John Gray
Individual (Previous)
First Name (New)* Rick
Last Name (New)* Phillips

NEW Legally Reflects any revisions above
Responsible Rick Phillips
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 1067, 0, Lexington, NC 27292-6732
Address (Previous)
NEW Permittee Street Address
Mailing Address* 1673 Aviation Way
Address Line 2
City State / Province / Region
Lexington NC
Postal / Zip Code Country
27292-6732 United States
Permittee Street 1673 Aviation Way, 0, Lexington, NC 27292-
Address (Previous) 6732
NEW Permittee Street Street Address
Address* 1673 Aviation Way
Address Line 2
City
State / Province / Region
Lexington
NC
Postal / Zip Code
Country
27292-6732
US
Change Requested Rick Phillips via Modification request submitted 4/12/2022.
by: * Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation Updated billing contact e-mail and phone as well.
(Optional)
Date * 04/13/2022