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 r-2

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 Letter or Notice of Violation, please enter the number below.

Please print or type all items. If not applicable, mark N.A.

11

Exterior ADDRESS DESIGNATED FLOOR OR AFORT EW

PROPERTY Manhattan BLOCK 2ONPKG DETAILED DESCRIPTION Removal of debris (cleaning, 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/ NNkrL TIRE & tttM (If mctK:able( CO-OP SHAREHOLDER ND0RE55 APT • CRY STATE SP CODE NIA ARCHITECT/ NNh5. 1T115 a FKW (ft ccoicovlel PHONE Iotm ENGINEER If applicable ADofSS aIr 5152E aP CODE

Fiber Control, Inc. (516) 781-3000 CONTRACTOR NNE, TIRE s FraM to molrmlel WME OM If applicable 3010 Burns Avenue Wantagh, New York 11793 ADDF&W CITY 5151E DP CODE

PERSON FILING NYC Department of Environmental Protection (718) 595-3718 APPLICATION NNME 111LE & FIRM (a OPdx:odel Ptl hart e.g. Expeditor. Attorney. Monogmg Agent, etc. 59-17 Junction Boulevard, 8th Floor Corona_ NF-w Ynrk ADORE55 Ctiv. STATE. ze OOE 11368

ARE YOU APPLYING TO ANY OF THE FOLLOWING? 0 Buildings Department 0 City Planning Commission ❑ Board of Standards & Appeals

lam the owner of the above listed property. I am familiar wiry, ,'-,9 .. irk 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 apphratrons to, work on or in a doopera We or wndominIum bs#dmp. OWNERS NAME Gray 1111E (please tree or pnrrtl PHONE (Carl the •owner is the Coop Board a Condominlum Association. An officer of the Coop Board or Condominlun COMPANY. CORPORATION. ORGAMUVION (r opocobe( Association must sign thin application Please rnnsull the instructions for Fong for additional Information

NYC DEP for owner - SIGNATURE aCsNATME OF OWNER — — -- DATE

Note: Section 25-317 of the Administrative Code of the City of New York makes lift punishable offense to willfully make false statements on This application La. wc•.

NYC-WTC 000093898