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

APPLICATION FORM FOR WORK ON DESIGNATED PROPERTIES r2

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 toe Warning Letter or Notice of violation, please enter the number below. Please print or type all items. If not applicable, mark N.A.

DATE CERT. AS COMPLETE BLDG. DEPT. • & DATE UTAFF I

Exterior DESIGNATED ADDRM FLOOR OR MBSIMPI!

PROPERTY Manhattan BOROUGH BLOCK LOT ZONING DETAILED DESCRIPTION Removal of debris (cleaning 1 from the collapse of the WTC OF PROPOSED WORK from exterior building Use back of form if necessary surfaces as per scope of work previously Y reviewed and approved by NYCLPC.

COST OF PROJECT WARNING LETTER / NOV # NIA TENANT/LESSEE/ MEAL TITLE & FIRM (d dppliCoble) PMONE Idori CO-OP SHAREHOLDER ADDRESS APT I QTY STATE. ZIP CODE NIA ARCHITECT/ NAME. TITLE & FIRM (K oppecoble) wfOhE (dart ENGINEER If applicable ADDRESS arr stATE. ZIP coca Fiber Control, Inc. (516) 781-3000 CONTRACTOR NAME TITLE & FIRM Id oppi cable) wfOPE Idpvl If applicable 3010 Burns Avenue Wantagh, New York 11793 ADDREss CRY SLATE. ZIP CODE

PERSON FILING NYC Department of Environmental Protection (718) 595-3718 APPLICATION NAME. TITLE & FIRM (if opoix cWl PHONE TdOsl e.g. Expeditor, Attorney Monogng Agent. etc. 59-17 Junction Boulevard, 8th Floor Corona NPw Ynrk 11368 ADDRESS CRY, s1ATE. ZIP ODE

ARE YOU APPLYING TO ANY OF THE FOLLOWING? ❑ Buildings Department 0 City Planning Commission 0 Board of Standards & Appeals lam the owner of the above listed property. I am familiar wilt. .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 apphcaiwns for work an or in a eooperathre or condominium buidkp. OWNERS NAME ono TITLE (please Moe or pistil P 40N€ (donl ore 'owner' is the Co-op Board or Condominium Assodation. M dfrroer of the Co-op Board or CondantMum COWMANY. CORPORATION. ORGANIZP JqN It opdcobiel Association must son It" appleation Please consult the instrurybm for Fare for addebnal kdornratlon, A tES5 COY. 55511. lot COOK

NYC DEP for owner SIGNATURE SIGNATURE OF OWNER — -- DAR

Note. Section 25-31? of the Administrative Code of the City of New York makes it a punishable offense to willfully make raise statements on this application o... on'.

NYC-WTC 000093895