LPC Application Form for Designated Properties, Sept 2006

NYC 9/11 Public Portal Document

THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION POMA? I CENTRE STREET, 9TH FLOOR, NEW YORK, NEW YORK, 10007 TEL: (212) 669- 7700 FAX: (212) 669-7960

ERVt+•~ APPLICATION FORM FOR WORK ON DESIGNATED PROPERTIES F.2

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 Cl INTERIOR ,'PE OF OEs4wNATION HISTORIC DISTRICT

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

Exterior ADDRESS FLOOR OR APARTMENT DESIGNATED PROPERTY Manhattan BOROUGH LOT ZONING

DETAILED DESCRIPTION Removal of debris (cleaning) from the collapse P 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 Of applicable) PHONE (day) CO-OP SHAREHOLDER ADDRESS APT N CSY. STATE. ZIP CODE

NIA ARCHITECT/ NAME, TITLE & FIRM (II applicable) PHONE (ODy) ENGINEER If applicable ADDRESS CITY, STATE. ZIP CODE

CONTRACTOR NAME, TITLE & FIRM (II applicable) PHONE (day)

If applicable ADDRESS CRY, STATE, ZIP CODE

PERSON FILING NYC Department of Environmental Protection (718) 595-3718 APPLICATION NAME TITLE & FIRM (It applicable) PHONE (day)

e.g. Expeditor, Attorney, Managing Agent, etc. 59-17 Junction Boulevard, 8th Floor Corona. NPw Ynrk 11368 ADDRESS CITY, STATE, ZIP &)OE

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

I am the owner of the above listed property. I am familiar with the work proposed to be carried out on my property and give my permission for this application to be (led. 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, OWNER'S NAME and TITLE (please type or odnt) PHONE (ploy) the owner Is the Co-op Board or Condominium Association. An officer of the Coop Board or Condominium COMPANY, CORPORATION. ORGANIZATION (If applicable) Association must sign this application. Please Consult the Instructions for Filing for additional information. ADDRESS CTI'I STATE. ZIP CODE

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. Pe cow

NYC-WTC 000093609