Landmarks Preservation Commission work application form F-2, undated

NYC 9/11 Public Portal Document t•fy t i

THE CITY OF NEW YORK LANDMARKS PRESERVATION COA94MION ~a0 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 Fz, 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 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.

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

❑ INDIVIDUAL 0 SCENIC 0 INTERIOR

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

Exterior DESIGNATED ADDRESS Roca 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 (II opplcoblol PHONE 1~9 CO-OP SHAREHOLDER ADDRESS APT ♦ CITY, STATE. ZIP CODE NIA ARCHITECT/ NAME, TIRE & FIRM it applicable) PHONE Idovl ENGINEER If applicable ADDRESS CRY STATE ZIP CODE Trio Asbestos Removal Corp. (718) 961-4100 CONTRACTOR NAME TITLE & FIRM (It applicable) PHONE (aap) If applicable 14-20 129 Street College Point, New York 11356 ADDRESS CTIY, STATE ZIP CODE

PERSON FILING NYC Department of Environmental Protection (718) 595-3718 APPLICATION NAME mLE & FIRM Of applicable) PHONE (port e.g. Expeditor, Attorney, Monoging Agent. etc. 59-17 Junction Boulevard, 8th Floor Corona New York 11368 ADDRESS C11V, STATE. ZIP~O

ARE YOU APPLYING TO ANY OF THE FOLLOWING? ❑ Buildings Department ❑ City Planning Commission 0 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 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 (Please type or PrInl) PHONE (doe) tie'ownef Is the Coop Board or Condominium Association. An officer of The Co-op Board or Condominium COMPAM; CORPORATION. ORGANIZATION (i applicable) Association must sign this application Please consult the Instructions for FEng for additional Information. ADDRESS CITY 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. 'xw tic

NYC-WTC 000093882