WTC debris clean-up application form, June 2002

NYC 9/11 Public Portal Document a•u ., av[~ Lilt s iVLVLF%i JS.i 5Kl c..Y R£ J' wnana:,auaVN ~ - --y v- - - 1 CENTRE STREET, 9TH FLOOR, NEW YORK, NEW YORK. 10007. TEL (212) 669- 7700 FAX (212) 669-7960

C APPLICATION FORM v FOR WORK ON DESIGNATED PROPERTIES t:2 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 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 NA

C t OCIon a DATE RECV DAVE CERT. AS COMPLETE ILDG. DEPL • & a1E SW+

O NDMOUSL O C NTERIOR

PMW A U RE ,CTION OTHER WORK TYPE

DESIGNATED 2 PROPERTY Manhattan aoaa~Grf BLOCK ton 27wGG DETAILED DESCRIPTION Removal of debris (cleaning) from the collapse of the WTC OF PROPOSED WORK from exterior building Use back of form It necessary surfaces as per scope of work previously reviewed and approved by NYCLPC.

COST OF PROJECT WARNING LETTER / NOV # NIA TENANT/LESSEE/ rwA.E. TIRE a rre,s to aaaic.abiel Fnor* loon CO-OP SHAREHOLDER ADDWM APT • ar Sws.11P CODE NIA ARCHITECT/ HAM. TIRE a FRM td cop+rcobbl PCCPE local ENGINEER K applicable AOORE55 M. sws. Jw coos

Fiber Control, Inc. (516) 781-3000 CONTRACTOR "Mc TIRE a P115.4 W aoprcabiet prey looyl If applicable 3010 Burns Avenue Wantagh, New York 11793 ADor ss Cm SWE DP CODE PERSON FILING NYC Department of Environmental Protection (718) 595-3718 APPLICATION ++ME uLE&FQMI1onoIcobiet pHOPEIcoA

e'g MonogAg ExPee~t 59-17 Junction Boulevard, 8th Floor Corona New Vnrk ADDRESS C11 STATE f ODE 11368

ARE YOU APPLYING TO ANY OF THE FOLLOWING? ❑ Buildings Department ❑ City Planning Commission 0 Board of Standards & Appeals lent the owner of the above listedproperty. I am familiar with the v.,ork proposed to be carried out on m. ; • r petty and give my permission for this application to be filed. The information entered is correct and complete, to best of my knowledge. _ OWNER ,to9 For appkcatwo far work on or in a moparawaa mndmik.kanbrradaq. aN •ownr s lie Coop Board a Condomk,Yim Assodnbn. Ar C Roar of M Coop Board or Condorr*Wm Assodstbn must sign wk srpplCaten. PMsse oonsuR Sm. Inakucbons for F" for addnbnal kdonnadon. PII SIGNATURE Note. Seckon 25-317 of the Administrative Code of the City of New York makes a a punrsheble offense to wdlfuly make false statements on this appkeation ow w.

NYC-WTC 000093911