LPC Application Form for Work on Designated Properties, Sept 2002

NYC 9/11 Public Portal Document

THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION ~OM4,p 1 CENTRE STREET, 9TH FLOOR, NEW YORK, NEW YORK, 10007 TEL: (212) 669- 7700 FAX: (212) 669-7960

APPLICATION FORM F2 FOR WORK ON DESIGNATED PROPERTIES This application will not be deemed complete until it is so certified by the Landmarks Preservation Commission. An application consists of an application form and the materials necessary to describe the project fully. If being submitted in response to a Warning Letter or Notice of Violation. please enter the number below. Please print or type all items. If not applicable, mark N.A.

PC DOCKET # DATE RECD DATE CERT. AS COMPLETE BLDG. DEPT. # & DATE STAFF

0 INDIVIDUAL 0 SCENIC ❑ INTERIOR (RE OF DESIGNATiON HISTORIC DISTPCT

PMW 0 CNE 0 C OF A p REPORT ACTION OTHER WORK TYPE

Exterio DESIGNATED ADDRESS FLOOR OR APARTMENT

PROPERTY Manhattan BOROUGH BLOCK LOT ZONING DETAILED DESCRIPTION Removal of debris (cleaning) g from the collapse of the WTC OF PROPOSED WORK from exterior building surfaces as per scope of work Use back of form if necessary previously reviewed and approved by NYCLPC.

COST OF PROJECT WARNING LETTER / NOV # NIA TENANT/LESSEE/ NAME. TITLE & FIRM (It applicable) PHONE (day) CO-OP SHAREHOLDER ADDRESS APT # CITY, STATE. ➢P CODE

NIA ARCHITECT/ NAME. TITLE & FIRM (It applicable) PHONE (doyl ENGINEER If applicable ADDRESS CITY. STATE. ➢P CODE

CONTRACTOR NAME. TITLE & FIRM (If applicable) R40W (day) If applicable ADDRESS CRY. STATE. ➢P CODE

PERSON FILING NYC Department of Environmental Protection (718) 595-3718 APPLICATION NAME, TITLE & FIRM (It applicable) PHONE (ploy) e.g. Expeditor, Attorney, Monoging Agent, etc. 59-17 Junction Boulevard, 8th Floor CoLona,~IewYork 11368 ADDRESS CITY, STATE, ➢P ODE

ARE YOU APPLYING TO ANY OF THE FOLLOWING? 0 Buildings Department 0 City Planning Commission 0 Board of Standards & Appeals

lam the owner of the above listed property. lam familiar with the work proposed to be carried out on my property and give my permission for this application to be riled. The information entered is correct and complete, to the best of my knowledge. OWNER For applications for work on or In a cooperative or condominium building, OWNERS NAME and TITLE (Dlease type at print) PHONE (day) the owner is the Co-op Board or Condominium Association. An officer of the Co-op Board or Condominium COMPANY. CORPORATION, ORGANIZATION (i1 applicable) Association must sign this application. Please consult the Instructions for Filing for additional information. ADDRESS CITY STATE. TiP C0C

NYC DEP for owner SIGNATURE SIGNATURE OF OWNER DATE

Note: Section 25-317 of the Administrative Code of the City of New York makes it a punishable offense to willfully make false statements on this application. Ito, ^vc

NYC-WTC 000093600