NCC220435_Contact Update Record_20240501

Action History (UTC-05:00)Eastern Time(US&Canada)
Submit by bethany.georgoulias 5/1/2024 9:51:59 AM(Contact Changes Submitted)

Contact • - for • • • ONLY)
updatesThis form • . .
Certificate of NCC220435
Coverage(COC) No.* Enter the Certificate of Coverage Number(Use capital letters)
NC Reference No. NCG01-2022-0435
Original NOI No.* 78966
Project information associated with this permit(cannot change):
Permittee Listed Organizaiton cannot be changed(new COC required)
Broad River Village Group LLC
Project Name Broad River Village
Address 79 Morris Road,Asheville,NC
County Buncombe
Latitude 35.5205
Longitude -82.6112
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Prior Rescission Date This field will populate only if COC has already been rescinded.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. 216.543.1676
NEW Billing [phone]
Telephone No. (optional)
Legally Responsible Individual Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Legally Responsible Scott Gillespie
Individual(Previous)
First Name(New)* Will
Last Name(New)* Lynch

NEW Legally Reflects any revisions above
Responsible Will Lynch
Individual*
Permittee Email [e-mail]
(Previous)
NEW Permittee [e-mail]
Email*
Permittee Telephone [phone]
No.(Previous)
NEW Permittee [phone]
Telephone No.*
Permittee Mailing 10474 Broadview road,0, Broadview Heights,
Address(Previous) OH 44147-4455
NEW Permittee Street Address
Mailing Address* 2211 Medina Road
Address Line 2
Suite 100
City State/Province/Region
Medina OH
Postal/Zip Code Country
44256 usa
Permittee Street 10474 Broadview road,0, Broadview Heights,
Address(Previous) OH 44147-4455
NEW Permittee Street Street Address
Address* 2211 Medina Road
Address Line 2
Suite 100
City State/Province/Region
Medina OH
Postal/Zip Code Country
44256 usa
Site Contact Information
REVISE ONLY WHERE NECESSARY. KEEP INFORMATION THESAME IF NO CHANGES!
Site Contact Scott Gillespie
(Previous)
Site Contact Title
(Previous)
Organization
(Previous)
First Name(New)* Will
Last Name(New)* Lynch

NEW Site Contact* Reflects any revisions above
Will Lynch
NEW Site Contact Land Development Manager
Title
NEW Organization Broad River Village Group LLC
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 216.543.1676
Telephone No.
(Previous)
NEW Site Contact [phone]
Telephone No.*
Site Contact Mailing 10474 Broadview Road, 0, Broadview
Address(Previous) Heights, OH 44147-4455
NEW Site Contact Street Address
Mailing Address* 2211 Medina Road
Address Line 2
Suite 100
City State/Province/Region
Medina OH
Postal/Zip Code Country
44256 usa
Change Requested Will Lynch(Land Development Manager)via Modification request submitted
by:* 4/30/2024.
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