NYC 9/11 Public Portal Document
THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION
1 C TRE STREETTH9 FLOOR, NEW YORK. NEW YORK, 10007.
TEL: (212)669-7700FAX(212)669-7960
O APPLICATION FORM
FOR WORK ON DESIGNATED PROPERTIES
This application will not be deemed complete until it Is so certified by the Landmarks
• Preservation Commission. An application consists of an application forth and the materials
necessary to descn'be the project fully. If hero;; 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 NA.
OOCW • DATE RECD OATS CERT. AS COMPLETE KDG. DEPL a & DATE STAFF
O rroncu.,t O SCENic C rmaaR
Pmw A O RE
LION OTHER WORK TYPE
Exterior
DESIGNATED
PROPERTY Manhattan 1 4 (o 2,
BOROUGH BLOCK LOT ZONNG
DETAILED
DESCRIPTION Removal of debris (cleaning) from the collapse of the WTC
OF PROPOSED WORK from exterior building surfaces
Use back of form d necessary as per scope of work
previously reviewed and approved by NYCLPC.
COST OF PROJECT WARNING LETTER / NOV #
NIA
TENANT/LESSEE/ NAME.ITTLE&FIRMttlroOfcadet Mot*1000
CO-OP SHAREHOLDER
AD RESS APT I CITK STATE. aP CCOE
NIA
ARCHITECT/ NM.£ mLE & FAM N apptcabtel wtONE (aopl
ENGINEER
If applicable
Amass arc STATE.. DP CODE
Fiber Control, Inc. (516) 781-3000
CONTRACTOR ttaAL mE a FFat a cptacaatei mtowE taorl
If applicable
3010 Burns Avenue Wantagh, New York 11793
Atx ss arc suvE Jp cooE
PERSON FILING NYC Department of Environmental Protection (718)
595-3718
APPLICATION k4kc uaFRMNaaoreabler PHONEldovl
e.g. EKQeWtar.An etc.
►Aonogng Agent etc. 59-17 Junction Boulevard, 8th Floor C_nrnna Uow Ynrk 11368
Aoofrfss CRY, STATE. _
DP~OOE
ARE YOU APPLYING TO ANY OF THE FOLLOWING?
O Buildings Department O City Planning Commission O Board of Standards & Appeals
lam the owner of The above listedproperty. lam familiar with the crock proposed lo be canted out on
my property and give my permission for this application to be filed. The information enteredis correct
and complete, to the best of my -.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-.-
OWNER
F«awknor+abrwortonorina
coo9«ab" or mwarankon tfrrada g
fTFK.B T /'4 knowffedge~~
o ►„t,ll.de / L
OWNERS NM.E on TITLE (Weore tmoe or prvi
P11
EN 'owrwt• s the Coop Board or
the Co-op Board or Condonvntrm
Assodawn must aqn
Pla.N canoe the tnatrueaons br Farq i
br adddM,al Monson.
NYC DEP l w~t f or owner ~J~~QL
SIGNATURE NGNAneRE OF ot,E I
NOW Section 25.317 of Be AdnwrtslrBtve Code of the Cdy of New York makes A a punishable offense to wildupy make false statements
on tEds apgBnkon
NYC-WTC 000093919
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