Landmarks Preservation Commission work application form F-2, undated

NYC 9/11 Public Portal Document

THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION tt9 1 CENTRE STREET,9TH FLOOR,NEW YORK,NEW YORK.10007 TEL: (212)669- 7700 FAX:(212)669-7960

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 enterthe number below. Please print or type all items. If not applicable, mark N.A.

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

0 INDMDUAL ❑ SCENIC ❑ INTERIOR APE Of DESTGNATION HISTORIC DISTTECT

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

Exterior ADDRESS FLOOR OR APARTMENT DESIGNATED PROPERTY Manhattan BOROUGH BLOCK 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 ifnecessary previously reviewed and approved by NYCLPC.

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

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

Trio Asbestos Removal Corp. (718) 961-4100 CONTRACTOR NAME, TITLE & FIRM (II applicable) PHONE (dal If applicable 14-20 129 Street College Point, New York 11356 ADDRESS CITY. STATE. ZIP COOT

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

e.g. Ezpeditor,Attorney, Managing Agent, etc. 59-17 Junction Boulevard, 8th Floor Corona, New Ynrk 11368 ADDRESS PP CITY. STATE, Oti

ARE YOU APPLYING TO ANY OF THE FOLLOWING? ❑ 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 filed. 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 pdnt) PHONE (day) the 'owner Is the Co-op Board or condominium Association. An officer of the Co-op Board or Condominium COMPANY. CORPORATION, ORGANIZATION It applicable) Association must sign this application. Please consult the Instructions for Filing for additional Information. ADDRESS CLIV. 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. '•5 rx

NYC-WTC 000093880