WTC debris clean-up application form, June 2002

NYC 9/11 Public Portal Document " v• a•a.•r av[~ Lt u ,% Y ATLf►tll4l r KC.i1LKV llv'wl•at •a:.auavl♦ 9.9 Mdp~ --y v_ - • I CENTRE STREET, 9TH FLOOR, NEW YORK, NEW YORK. 10007. TEL: (212) 669-7700 FAX: (212) 6697960

APPLICATION FORM FOR WORK ON DESIGNATED PROPERTIES l<2 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. It 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

PC DOCIa a DA1E RECD DAVE CERT. AS COMPLETE IIDG. DEPL • & DAIS StAff

O e,onnou&t O scc C WTERtce

Pk'1W A U RE ION OTHER VNTIK TYPE

2 Exterior DESIGNATED FLoOR or APARTMM

PROPERTY Manhattan g~ (I boAcJIJGH BLOCK LOT 2OI* G 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/ fate. MILE & MM is aaoroble) PIIDrE toc" CO-OP SHAREHOLDER ADDRESS APT • ar STALE ap CODE NIA ARCHITECT/ *ai. TmEaFRM(scookmote) a~orrElooA ENGINEER K applicable 'emu CRY. 5UiE. DP CODE

Fiber Control, Inc. (516) 781-3000 CONTRACTOR k*& U E a FRM a ooatcat>fe) waNE loos) If applicable 3010 Burns Avenue Wantagh, New York 11793 ADOc45u nn: STATE. DP CODE PERSON FILING NYC Department of Environmental Protection (718) 595-3718 APPLICATION D+ME MU&FAMnoppbcowel PHONEt e.c «.Anor c. Monoging Apent etc' 59-17 Junction Boulevard, 8 h AooREss Cm: STATE. DP &M 11368

ARE YOU APPLYING TO ANY OF THE FOLLOWING? O Buildings Department O City Planning Commission OBoard of Standards & Appeals I am the owner of the &bore listedproperty. I am familiar with the tor* proposed to be carried out on r' . ; • r.p.rty and give my permission for this application to be riled. The information entered is correct and complete best of my knowledge. OWNER ~ For.pplic.Iionsbr,aakonMin. XU V N(ct_dl Clh PII ._._._._._._.L._._._._._._._._._._._._._b...........~.~.~.~.~.~.~.~.~.~.~.~.~.~.—. mapsrawa a wldanC ken bade p. .+.'owners o Con. Board dRnor I I a CWonWJrm Aeeo~lHgn. An oer of IM Co-op board or condon*Wm Aseocietlon must s1 n ade applkaton. PWsa conwK rM tnetn,ebm$ for __ b, addlt nal kdomrtbn. '~ :E -~ _._._._._._._._._ _._. _ ._._._._._._._. ._._. . _._ _._r ._. _______ ________ -~nn -/, NYC DEP p A -A_IU - l ~ for owned SIGNATURE sIGNATwE or owgE — - — Note. Secs on 25-317 of the Admirlistrsbve Code of the Cdy of New York makes it a punishable offense to wdlupy make false slalemene on ate appkcabon ow w.

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