WTC debris clean-up application form, June 2002

NYC 9/11 Public Portal Document ..~ ;w.~.: 'l p.t ,s' i's,.- ~:'~i, '• v`.Nfn.',~ 'S a '•' . .i r q M.,<'

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

APPLICATION FORis FORM K ON be Fs DESIGNATED PROPERTIES Wiccattiion will deemed complete it Is ed 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.

titan use Ofl

PC DOCKET 1 DATE RECD DATE CERT. AS COMPLETE BLDG. DEPT. # & DATE STAFF

❑ INDMOUAL 0 SCENIC C INTERIOR

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

Exterior DESIGNATED ADDRESS FLOOR OR

PROPERTY Manhattan BOROUGH BLOCK LOT ZONBJG 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. TIRE & FIRM (II applicable] RiONE(dart CO-OP SHAREHOLDER ADDRESS APT • 01Y. SINS. ZIP CODE NIA ARCHITECT/ NAME TITLE & FIRM (If opptiCablel R,10NE (dart ENGINEER If applicable ADDRESS CITY, STATE. DP CODE

Fiber Control, Inc. (516) 781-3000 CONTRACTOR NAME TIRE & FIRM Id appliwbial PHONE (coyl If applicable 3010 Burns Avenue Wantagh, New York 11793 ADDRESS CIY: STATE. ZIP CODE

PERSON F1:.ING NYC Department of Environmental Protection (718) 595-3718 APPLICATION NAME TITLE & FIRM (a oppcaae) PHONE (dart e.g. Expeditor, Attorney, Manoging Agent, etc. 59-17 Junction Boulevard, 8th Floor Coroner. NPw York 11368 ADDRESS - CITY. STATE. ZIP ICOE

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 wiry ...,rk proposed to be carried out on my property and give my permission for this application to oe riled. The information entered is correct and complete, to the best of my knowledge. OWNER For applications to, work on or in a cooperative w condominium building. OWNERS NAME and TILE (please type or pnMl PHONE (day) Bra -owner is the Co-op Board or Condominium Association. An office, of the Co-op Board or Condominium COMPANY. CORPORATION. ORGANIZATION It oppicade) Association must sign this application Please census the instructions, for Filing for additional Information

NYC DEP for owner SIGNATURE SIGNATURE OF OYMER - --- 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 ow WV.

NYC-WTC 000093891