WTC debris clean-up application form, June 2002

NYC 9/11 Public Portal Document THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION ~,oM•(,p 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 Fz - 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 enterthe numberbelow. Please print or type all items. If not applicable, mark NA

use o

PC DOCKET • DATE RECD DATE CERT. AS COMPLETE BLDG. DEPT. a & DATE STAR

❑ INDIVIDUAL. ❑ SCENIC C INTERIOR

PMW 7 OlE 0 COFA 0 REPORT 'ChOrd OTHER WORK TYPE

Exterior DESIGNATED Alma FLOOR OR APARTMENT

PROPERTY Manhattan BOROUGH BLOCK LOT ZOMl G 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 reviewed and approved by NYCLPC.

COST OF PROJECT WARNING LETTER / NOV # NIA TENANT/LESSEE! NAk~E. TITLE & mt. tr 000kcablel PHONE lock! CO-OP SHAREHOLDER ADDRESS APT • CT STATE. ZIP CODE NIA ARCHITECT/ IwME. TITLE & FIRM m 000xcaael PHONE low ENGINEER If applicable ADDRESS CITY, STATE. ZIP CODE

Fiber Control, Inc. (516) 781-3000 CONTRACTOR NAk'E. TITLE & FUM m oppkt.ablel PHONE kiwi If applicable 3010 Burns Avenue Wantagh, New York 11793 ADDRESS CITY. STATE. ZIP CODE

PERSON FILING NYC Department of Environmental Protection (718) 595-3718 APPLICATION wNE. TnLE & FIRM m ooacablel PHONE wwI e.g. Expeditor. Afforney. MonogmgAgent,etc. 5~9DRE~7 Junction Boulevard, 8th Floor gram New Ynrk 11368 CRv STATE. ZR CppE

ARE YOU APPLYING TO ANY OF THE FOLLOWING? ❑ Buildings Department 0 City Planning Commission ❑Board of Standards & Appeals lam the owner of the above listed property. I am familiar wilt, ; e .; k 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 applicatbna for work on or To . aooperatke or condamnkrm bWdrg. O HERS NAME and TITLE (please type or pmt) PHONE Iddyl me -owner IS the Co-op Board « Condominium Association. An Bo,. of the Co-op Board or Condomnkun WMPIVNY. CORPORATION. ORGANIZATION If opocoDiel Association must sign Bits applkatcn Phase aonsuf the Instructions far Fling for addlllonal information ADDRESS

NYC DEP for owner SIGNATURE SrNATURE OF OWNER — DATE

Note: Section 25-317 of the Administrative Code of the City of New York makes it a punishable offense to will)uEy make false statements on this application a- 4N.

NYC-WTC 000093899