WTC debris clean-up application form, June 2002

NYC 9/11 Public Portal Document :r. a"

THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION . •, ;+;:, , ~a0 1 CENTRE STREET 9TH FLOOR, NEW YORK, NEW YORK, 10007 " TEL: (212) 669- 7700 FAX: (212) 669-7960

APPLICATION FORM Fz 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 form and the materials necessary to describe the project fully. If being submitted in response to a Warning Letter or :4 Notice of Violation. please enter the number below. Please print or type all items. If not applicable, mark NA

.PC DOCKET a DATE RECD DATE CERT. AS COMPLETE BLDG. DEPT. I & DATE STAFF

❑ WDutDuAL O SCENIC O INTERIOR YPS Of DESEdNAIlON HISTORIC DISTRICT

o PMW ACTION O CNE O C Of A REPORT OTHER WORK TYPE

DESIGNATED O6 AooRESS mar den G ►1✓ ` 3"L 7 e - s) FLOOR OR APA D" Exterior

PROPERTY Manhattan BOROUGH 92.BLOCK 3/ LOT ZONING 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. TITLE & R W (If applicable) PHONE (dw) CO-OP SHAREHOLDER ADDRESS APT « CITK STATE. ZIP CODE NIA ARCHITECT! NAME. TITLE & FIRM (IT applicable) PHohIE (dod ENGINEER If applicable ADDRESS CITY. STATE. ZIP CODE Trio Asbestos Removal Corp. (718) 961-4100 CONTRACTOR IW. RILE & F M (B appltcable) PHONE tons) If applicable 14-20 129 Street College Point, New York 11356 ADDRESS CITY. STATE. ZIP CODE

PERSON FILING NYC Department of Environmental Protection (718) 595-3718 APPLICATION NAME TITLE & FIRM (If applicable) PHONE ldah e.g. Expeditor. Attorney. Managing Agent. etc. 59-17 Junction Boulevard, 8th Floor Corona NPw York 11368 ADDRESS CITY. STATE. ZIP.ODE

ARE YOU APPLYING TO ANY OF THE FOLLOWING? O Buildings Department O City Planning Commission ❑ Board of Standards & Appeals

I am the owner of the above listed property. lam familiar with the work proposed to be carried out on my property and give my permission for this application to be riled. The information entered is correct and complete, to the best of my knowledge. OWNER For applications for work on or in a cooperative or condominium building, the owner is the Co-op Board or Condominium Association. An officer of the Co-op Board or Condominium Association must sign this application Please consult the Instructions for Filing for additional information.

SIGNATURE Note: Section 25-317 of the Administrative Code of the City of New York makes it a punishable offense to willfully make false statements on this application.

NYC-WTC 000093925