WTC debris clean-up application form, June 2002

NYC 9/11 Public Portal Document inc1..11 Y Ur 1'Ir;W YUKK LANUMARKS PRFSERVAT!OPt C:UMNUbb1VN 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 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 toe Warning Letterer Notice ofViolation,please enter the number below. Please print or type all Items. If not applicable, mark N.A.

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OOCl T C OATS RECD DATE CERT. AS COMPLETE KM. DEPT. • & DATE EWF

0 WDNIOIIA1 0 SCENIC C WERIOR

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DESIGNATED '? AOORSS 2e-ae StL - FLOOR OR AFOARAW Exterior (ooF) PROPERTY Manhattan BOROUGH ~K TOT ioNuaG + 1 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/ NAM£ ins & FUiM to WplcoWel loovl CO-OP SHAREHOLDER aixxass APT R arc SINE DP CODE NIA ARCHITECT/ NAME ins t FE (U opoaco 4e1 PI tdon ENGINEER If applicable ADDRESS arc. SINE. Sr CODE

Fiber Control, Inc. (516) 781-3000 CONTRACTOR NAME ORE a FEW Pr cPPl'oObreI RfanE 1089 If opplicoble 3010 Burns Avenue Wantagh, New 'co, York 11793 ATx ss arc SINE D

PERSON FILING NYC Department of Environmental Protection (718) 595-3718 APPLICATION lW. . aru a ,sop p opohcoolel WIOPE taa4 e.g. Eipeditot. Anomey. Monoging Agent. etc. 59-17 Junction Boulevard, 8th Floor t-nrnna NPw vnrk 11368 ADDRE55 Cm. STATE Zip

ARE YOU APPLYING TO ANY OF THE FOLLOWING? ❑ Buildings Department ❑ City Planning Commission 0 Board of Standards & Appeals I am the owner of the above listed property. lam familiar with the vrork proposed to be carried out on my property and give my permission for this application to be riled. The information enteredis correct and complete, to the best of my knowledge. OWNER For appicatona for work on or in a epopsrao.~ or cord n .lam buEd,ng. f-fc,4-k1 MQska«,,tz OWNERS NWE and Tiiuu Wieose Noe or pnd1 2c z- 3q9- 3ya y aw 19—we. a ew Co-op Board or PHONE two CondonaNrm AssoWkon. M afsoa of trw Co-op Board or Condomt,sn Assoclston miel sign Cris spprcrCn PNsse oonW4 Ihs Inseumens for Fsiq br addibnat Momwoon

SIGNATURE Note: Section 25-317 of the AdminidntNe Code of the Coy of New York makes d a punishable offense to wdlfuay make false statements on ails app6oation ao-

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