Mitchell Community College - 3/25/2019 2:22:53 PM

Submittal Dated: 3/25/2019
Please note: fields marked with a red asterisk below are required. You will not be able to submit the form until all
mandatory questions are ansmred.
Existing Project Information:
Rease supply the perrrit nunber for this project.
D# * FL-rrrit Narrber
SW3180305
Exarrples: SWxxxxxxx, NOC;axxxx, or NCSxxxxxx
Facility Name:* Mitchell Community College
County: Iredell
Name: Griselda Ruan
Who is submitting the information?
Email Address:* [e-mail]
Please upload all files that need to be submited.
Qick the upload button or drag and drop files here to attach document
6028- MCC- REVISED SET.pdf 50.64MB
REVISED-6028-MCC Calc Book_Storm.pdf 9.31 MB
REVISED-SSW-SWU-1 01 -Application- DEMLR-SPU
1.23MB
Oct 2013.pdf
REVISED-6028_SSW-Su ppEZ-20170329-DEMLR
590.56KB
SW.pdf
Only pdf files are accepted.
Describe the attachments:
Please find attached the revised plan set, engineering calculations book, and applications per the project change
order. Hard copies have been mailed.
* V By checking the box and signing box below, I certify that:
o I have given true, accurate, and complete information on this form;
o I agree that submission of this Supplemental Information form is a "transaction" subject to Chapter 66, Article 40 of
the NC General Statutes (the "Uniform Electronic Transactions Act)
• I agree to conduct this transaction by electronic means pursuant to Chapter 66, Article 40 of the NC General Statutes
(the "Uniform Electronic Transactions Act');
o I understand that an electronic signature has the same legal effect and can be enforced in the same way as a written
signature; AND
o I intend to electronically sign and submit the Supplemental Information form."

Full Name:* Griselda Ruan
Signature:
Date Submitted: 3/25/2019

Initial Review
Updated ID#: IWORfANT: FEVIBAERSHOLLDVERIFY and revise here if necessary.
SW3180305
Who needs a V Central Office
copy?* F Regional Office
Central Office Reviewer:*
Corey Anen - eads\scanen
Select Reviewing Office*
Mooresville Regional Office — 704-663-1699
Select RO Reviewer:*
[e-mail]