NYC 9/11 Public Portal Document
AE r, a.ii x Ur FYLW YUKK LANDMARKS PRFSERVATIUN CUMMYubbLUt4
i 1 CENTRE STREET 9TH FLOOR, NEW YORK, NEW YORK. 10007.
APPLICATION FORM
TEL: (212) 669- 7700 FAX: (212) 669-7960
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FOR WORK ON DESIGNATED PROPERTIES
This application will not be deemed complete unto it is so certified by the Landmarks
Preservation Commission. M application consists of an application fonn and the materials
necessary to describe the project fully. If being submitted In response toe Warning Letter or
Notice ofViolation,please enter the number below.
Please print or type all items. If not applicable, mark NA
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C DOCKET i OWE RECD DATE CERT. AS COMPLETE RIDG. DEPT. • & DAZE fWF
0 WDNIOUA1 0 SCENIC C R(TSRIQR
A 0 REPORT
TION OTHER WORK TYPE
QZ
AOORES
2I e- a.ck S1 - Exterior (bop)
DESIGNATED FLOOR OR AND It
PROPERTY Manhattan (C
BLOCK TOT IoraFG
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! MAn%. TITLE & FY1M (p aao4caolel
CO-OP SHAREHOLDER
ADEX SS APT a QT1( STATE. SR COOS
NIA
ARCHITECT/ NAME TTR,E i ritFA P oppkcablel PAOWldo,T
ENGINEER
If applicable
ADOMM Cm, STATE SR CON
Fiber Control, Inc. (516) 781-3000
CONTRACTOR NWE MLE a FIRM P acpkoobteI FHow toa+9
Ifcppicable
3010 Burns Avenue Wantagh, New York
co, 11793
ATx ss CITY. STATE DP
PERSON FILING NYC Department of Environmental Protection (718)
595-3718
APPLICATION sw.E.una&F1Maocaicobtel PACINEfooyl
e.g. IO. Attorney
Monagoging Agent etc. 59-17 Junction Boulevard, 8th Floor cornea NPw Vnrk 11368
Aoor*M CITY. STATE. S
ARE YOU APPLYING TO ANY OF THE FOLLOWING?
❑ Buildings Department ❑ City Planning Commission 0 Board of Standards & Appeal;
I am the owner of the above listed property. I am familiar with the v ov* proposed to be carried out on
my property and give my permission for this application to be Lled. The information enteredis correct
and complete. to lire bestt ofmy knowledge. -.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.- -.-.-.-. -
OWNER
F« appkcatm a for work on or in a
aoopan Wa or c w"WAwe brM6.i .
f-f -6e4-1' M"1 f1 S La ki (*Z
OMVERS NAME and TITLE (please Nve a PSI
P11
trw •o.rrrr a aw co-op Boats « ++rweYt~41----------------
CondominkrmAssociation. M~at -.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.
aw Co-op eo..d « Condamtdum
Association must sign arcs appicatid,
Plssss oonsuE the lnsaxeooM f« Flung
lei additional Mormatbn ' ssr - Jq 1t c
NYC DEP C:&. for owr~e
SIGNATURE OGNATIMOF E --- DATr
Note: Section 25-317 of the Administrative Code of the City of New York makes e a punishable offense to willfully
make false statements an Otis apptcation
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NYC-WTC 000093918
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