Landmarks Preservation Commission work application form F-2, undated

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

APPLICATION FORM FOR WORK ON DESIGNATED PROPERTIES F2_

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 • DATE RECD DATE CERT. AS COMPLETE BLDG. DEPT. C & DATE STAFF

❑ INOMDUAL ❑ SIISNC 0 INTERIOR

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

Exterior DESIGNATED FL0011 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 Use back ofform it necessary scope of work Y reviewed and approved by NYCLPC. previously

COST OF PROJECT WARNING LETTER / NOV # NIA TENANT/LESSEE/ NAME TITLE & FIRM (K oppllcAael PHONE Idol CO-OP SHAREHOLDER ADDRESS APT C Cam: STATE. DP CODE NIA ARCHITECT! & FIRM N opplcoele( PHoriE (ooN ENGINEER If applicable ADDRESS CITY, STATE. DP CODE Trio Asbestos Removal Corp. (718) 961-4100 CONTRACTOR NAME TITLE & FRM (If applicable) PHONE (dcm If applicable 14-20 129 Street College Point, New York 11356 ADDRESS CRY. STATE ZIP CODE

PERSON FILING NYC Department of Environmental Protection (718) 595-3718 APPLICATION NAME. TITLE&FIRM(aciroi-pye) P14ONE(0 ,( e.g. Expedites, Attorney. Managing Agent etc. 59-17 Junction Boulevard, 8th Floor Corona NPw York 11368 ADDRESS CITY STATE. DP IODE

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. 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 one, In a ceoperakre or condominWm twllding. OWNERS NAME and TITLE (please type or pint) PHONE (don the owner is the Co-op Board or Condominium Association. An officer of the Co-op Board or Condominium COMPANY. CORPORATION. ORGANIZATION (If appacaplel Association must sign this application. Pbase consuft additional the Instructions to, Filing for Information ADDRESS CTT STATE. SF COCA 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. .

NYC-WTC 000093884