WTC debris clean-up application form, June 2002

NYC 9/11 Public Portal Document ., THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION '•' 1 CENTRE STREET.9TH FLOOR,NEW YORK,NEW YORK,10007. TEL: (212) 669- 7700 FAX: (212) 669-7960 •1 APPLICATION FORM Fz t. FOR WORK ON DESIGNATED PROPERTIES 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 Letterer Notice of Violation, please enter the number below. Please print or type all items. If not applicable, mark N.A.

Exterior DESIGNATED ADDRESS FLOOR OR PARTMEN11

PROPERTY Manhattan BOROUGH BLOCK LOT ZONING DETAILED DESCRIPTION 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 Y reviewed and approved by NYCLPC.

COST OF PROJECT WARNING LETTER / NOV # NIA TENANT/LESSEE/ NAI.E. TIRE s FIRM (If apoicableI CO-OP SHAREHOLDER ADORES$ APT • City. STATE ZIP CODE

NIA ARCHITECT/ NIA$. TITLE & FIRM (t coOYcoolel RfONE fW4 ENGINEER If applicable AOOREss an: STATE. ZIP CODE Fiber Control, Inc. (516) 781-3000 CONTRACTOR FkN.E• TITLE a MM (t Pta-a IdaO If applicable 3010 Burns Avenue Wantagh, New York 11793 ADDRESS CRY. StATE ZF CODE

PERSON FILING NYC Department of Environmental Protection (718) 595-3718 APPLICATION NNE. TIRE k FIRM (t apdicoblel PtIOTE (doll e.g. Esped•toi, Attorney. Monogmg Agent. etc. 59-17 Junction Boulevard, 8th Floor Corona. NPw York 11368 ADDRESS CITY. STATE. ZIP

ARE YOU APPLYING TO ANY OF THE FOLLOWING? 0 Buildings Department ❑ City Planning Commission 0 Board of Standards & Appeals lam the owner of the above listed property f am familiar wiry, ..,e .. ark 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 apptcalons la wore an or In a aoopeTat"e at condominium buadmg, OWNERS NAME and TITLE (plOose type a Pbhtl PHONE 1ooyl the 'owner a the Coop Board a Candomlolm Association. An OIBoar of Ike Co-op Board at CondanMWm COIuPANY.. CORPORATION. ORGAMZATION (a apdcoble( Aasocialbn must man Ba application Please consult the Inatruoflona for Fling to, additional Mormadon. ADDRESS cm StATS. 1W CoOt

NYC DEP for owner - SIGNATURE aGNANREOFOWNER

hole: Section 25.317 of the Administrative Code of the City of New York makes it a punishable offense to wilfully make false statements on this apptcathon an. wv.

NYC-WTC 000093892