NCC200136_Contact Update Record_20240226

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by Tev.Holloman 2/26/2024 10:50:40 AM (Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC200136
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2020-0136
Original NOI No.* 20368
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Lebanon Road,LLC
Project Name Northeast Village-Phase I
Address 6817 Lebanon Road, Mebane, NC
County Orange
Latitude 36.1120
Longitude -79.2413
Date COC Issued* 01/31/2020
Prior Rescission Date This field will populate only if COC has already been rescinded.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? Q No
(6) Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. [phone],ext.3147
NEW Billing [phone],ext.3147
Telephone No. (Optional)
Change Requested Gabi Tesoro,Accounting Clerk,via email on 2/26/24
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 02/26/2024