NYC 9/11 Public Portal Document
COMMISSION
THE CITY OF NEW YORK LANDMARKS PRESERVATION
YORK, NEW YORK,10007 t,
1 CENTRE STREET', 9TH FLOOR NEW
TEL: (212) 669- 7700 FAX: (212) 669-7960
APPLICATION FORM
FOR WORK ON DESIGNATED PROPERTIES
is so certified by the Landmarks
r{
This application will not be deemed complete until it application form and the materials r
Preservation Commission. An application consists of an
response to a Warning Letter or
necessary to describe the project fully. If being submitted in
Notice of Violation, please enterthe numberbelow.
Please print or type all Items. if not applicable, mark N.A.
29 -l-9Th-InfNU.2-~ <R('56; , 3 ,33)
ADDRESS FLOOR ORAFARTP,~tvl
DESIGNATED t
PROPERTY Manhattan Z O
BLOCK LOT IOMNG
BOROUGH
DETAILED
DESCRIPTION Removal of debris (cleaning) from the collapse of the.WTC
OF PROPOSED WORK from exterior building surfaces as per scope of work
Use back of form if necessary
previously reviewed and approved by NYCLPC.
COST OF PROJECT WARNING LETTER / NOV #
NIA
TENANT/LESSEE/ NAME. MLE & RUM (h opc l
CO-OP SHAREHOLDER
APT a CRY, STATE. SP CODE
ADDRESS
NIA
PHONE Oed
ARCHITECT/ NA . SALE & FgrM In opplicablel (
ENGINEER
If applicable CJn: STATE. DP COLE
ADDRESS
Trio Asbestos Removal Corp. (718) 961-4100
NAW. IUT.E & FIRM (a opPllcobtel PHIXRE
CO NTRACTO R (
If applicable 14-20 129 Street College Point, New York 11356
CITY. STATE ZIP COD_
ADDRESS
PERSON FILING NYC Department of Environmental Protection (718) 595-3718
NAME TIRE & FIRM (11 opPfic.`ablel
PHONE (datl
APPLICATION
e.g. Expeditor. Attorney. Carona. New Ynrk 11368
Managing Agent. etc.
59-17 Junction Boulevard, 8th Floor Cny STATE. 71P
ADDRESS
ARE YOU APPLYING TO ANY OF THE FOLLOWING?
0 Buildings Department 0 City Planning Commission 0 Board of Standards & Appeals
I am the owner of the above listed property. I am familiar with the work proposed to be carried out on
correct
my property and give my permission for this application to be filed. The information entered is
and complete, to the best of my knowledge.
OWNER
!2-135RR5o
For appleations for work on or lea
cooperative or condominium building.
the 'owner' is the Coop Board or
Condominium Association. An dfricer of
the Co-op Board or Condominium 4u
Association must sign this application
Please consult the instructions for Filing
for additional Information.
NYC DEl r - g"tE I bZ
SIGNATURE SIGNATURE OF
punishable offense to willfully make false statements on this application.
Note: Section 25-317 of the Administrative Code of the City of New York makes it a
NYC-WTC 000093912
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