NCC231579_Contact Update Record (Emails Only)_20240501

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 5/1/2024 9:40:24 AM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC231579
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2023-1579
Original NOI No.* 142177
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
159 RAD River, LLC
Project Name 159 Riverside
Address Riverside Dr.,Asheville, NC
County Buncombe
Latitude 35.5894
Longitude -82.5707
Date COC Issued* 04/01/2024
Prior Rescission Date This field will populate only if COC has already been rescinded.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
0 Yes
Billing Email [e-mail]
NEW Billing Email [e-mail]
Billing Telephone No. [phone]
NEW Billing [phone]
Telephone No. (optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Brennan Smith
Individual(Previous)
First Name(New)* Brennan
Last Name(New)* Smith

NEW Legally Reflects any revisions above
Responsible Brennan Smith
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 301 West Platt Street,Suite 144,Tampa, FL
Address(Previous) 33606-2292
NEW Permittee Street Address
Mailing Address* 301 West Platt Street
Address Line 2
Suite 144
City State/Province/Region
Tampa FL
Postal/Zip Code Country
33606-2292 us
Permittee Street 301 West Platt Street,Suite 144,Tampa, FL
Address(Previous) 33606-2292
NEW Permittee Street Street Address
Address* 301 West Platt Street
Address Line 2
Suite 144
City State/Province/Region
Tampa FL
Postal/Zip Code Country
33606-2292 us
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Chris Denome
(Previous)
Site Contact Title Director of Program Management
(Previous)
Organization The Beck Group
(Previous)
First Name(New)* Chris
Last Name(New)* Denome

NEW Site Contact* Reflects any revisions above
Chris Denome
NEW Site Contact Director of Program Management
Title
NEW Organization The Beck Group
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 220 West 7th Avenue, Suite 200,Tampa, FL
Address(Previous) 33602-2012
NEW Site Contact Street Address
Mailing Address* 220 West 7th Avenue
Address Line 2
Suite 200
City State/Province/Region
Tampa FL
Postal/Zip Code Country
33602-2012 us
Change Requested Brennan Smith via Modification request submitted 4/29/2024. Email updates only.
by:* Include any additional correspondence records in the Repository COC folder.
Additional Information for this update to contact information:
Addional Explanation
(Optional)
Date* 05/01/2024