NYC 9/11 Public Portal Document
THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION
S ::; D I CENTRE STREET. 9TH FLOOR, NEW YORK. NEW YORK.10007
TEL (212) 669- 7700 FAX (212) 669-7960 '': "
APPLICATION FORM
FOR WORK ON DESIGNATED PROPERTIES
F-2 r
This application will not be deemed complete until K is so certified by the Landmarks ,
Preservation Commission. M application consists of an application forth and the materials
necessary to describe the project fully. If being submitted In response to a Warning Letter or
Notice of Violation, please enterthe number below
Please print or type all items. If not applicable, mark N.A.
PC DOCKET • DATE RECD DATE CERT. AS COMPLETE BLDG. OEPf. • & DATE STAFF
❑ INDMDIDAI ❑ SCENIC 0 INTERIOR
VI'S Of U€I5NA1TON HISTORIC DISTRICT
PMW DCNE 0 COP A 0 REPORT
ACTION OTHER WORK TYPE
A -11=1X2 Exterior FQ e-)
DESIGNATED
PROPERTY Manhattan
BOROUGH
~p
BLOCK
4 LOT
g
ZOMNG
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/ NAruE. TRLE tk FYIM Is arocabte)
CO-OP SHAREHOLDER
ADORESS APT • CRT. STATE, DP CODE
NIA
ARCHITECT/ NAME TITLE & FIRM fu 000BcCblBI PHONE loovf
ENGINEER
If applicable
ADDRESS CRY, SLATE, ZIP CODE
Trio Asbestos Removal Corp. (718) 961-4100
CONTRACTOR NAME. TITLES FIRM (a oPPaCableI R 'E ldovt
If applicable 14-20 129 Street College Point, New York 11356
ADDRESS M. STATE, ZIP COVE
PERSON FILING NYC Department of Environmental Protection (718) 595-3718
APPLICATION NAME. TITLE a FQIM (a Opcecoblel AIO C loon)
e.g. Expeditor. Attorney:
Monogng Agent. etc. 59-17 Junction Boulevard, 8th Floor Coronp New York 11368
ADDRESS Cm, STATE. ZIP &)OE
ARE YOU APPLYING TO ANY OF THE FOLLOWING?
O Buildings Department 0 City Planning Commission 0 Board of Standards & Appeals
lam the owner of the above listed property. lam familiar with the work 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 applications for work on or in a
eooperiWe or condonmIMum building.
11
the 'owner is the Co-op Seeder
Condominium Association An ollcs, of
the Coop Board or Condominium
Association must Illgn this application
Please consult the Instructions for Filing
for additional information
NYC DEP for owner
SIGNATURE SIGNATURE OF OWNER DALE
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.
NYC-WTC 000093906
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