Landmarks Preservation Commission work application form F-2, undated

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

s Y~~ APPLICATION FORM Fz' FOR WORK ON DESIGNATED PROPERTIES This application will not be deemed complete unto It is so certified by the Landmarks Preservation Commission. An application consists of an application form and the materials ys 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 NA.

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DOCKET a DETE RECD DATE CERT. AS COMPLETE BLDG. DEPT. a & DATE STAFF

0 INOMDUAL ❑ ScENIC 0 WTERIOR TEE OF DESiGNATION HISTORIC DISTRICT

PMW ❑ CNE 0 C OP A 0 REPORT CTION OTHER WORK TYPE

Exterior DESIGNATED ADDRESS FLOOR OR APARTMENT

PROPERTY Manhattan BOROUGH BLOCK LOT ZONING DETAILED Removal of debris (cleaning) 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(Ifoppldablel PHoneloayl CO-OP SHAREHOLDER ADDRESS APT R CITY, STATE. ZIP CODE

NIA ARCHITECT/ NANTE. TITLE & FIRM pf applliable) PHONE tocYl ENGINEER If applicable ADDRESS CRY, STATE. ZIP CODE Trio Asbestos Removal Corp. (718) 961-4100 CONTRACTOR NAAnE. TITLE& FRM m applicable) PHONE (Ckm If applicable 14-20 129 Street College Point, New York 11356 ADDRESS CITY. STATE ZIP CODE

PERSON FILING NYC Department of Environmental Protection (718) 595-3718 APPLICATION NAME. TIRE & FIRM m applicable) PHONE (aart e.g. Ekpedla,Anomey. MorxTggirtg Agent• etc. 59-17 Junction Boulevard, 8th Floor Corona New York 11368 ADDRESS CITY, STATE

ARE YOU APPLYING TO ANY OF THE FOLLOWING? 0 Buildings Department 0 City Planning Commission 0 Board of Standards & Appeals I am 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 eondominlum building, OWNERS MANY and TITLE (please Npe a Printl PHONE (dWl the owner is the Co-op Board or Condominium Assoclatkm. An officer of the Co-op Board or Condomkslum COMPANY. CORPORATION. ORGANIZATION (if applk%ablel Association must sign this application. Please consult the Instructions for Fking for additional Information ADDRESS CITY STATE. ZIP COOT

NYC DEP for owner SIGNATURE SIGNATURE OF OWNER

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. ~e. YW

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