NYC 9/11 Public Portal Document
THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION
I CENTRE STREET. 9TH FLOOR, NEW YORK, NEW YORK, 10007
TE3.: (212) 669- 7700 FAX: (212) 669-7960 &;
APPLICATION FORM
FOR WORK ON DESIGNATED PROPERTIES
F4
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
Notice of Violation. please enter the number below.
Please print or type all Items. If not applicable, mark NA
Staff Use
PC DOCKET • DATE RECD DATE CERT. AS COMPLETE BLDG. DEPT. • & DATE STAFF
❑ WOMDUAL ❑ SCENIC 0 INTERIOR
PMW ❑ CNE 0 COFA 0 REPORT fl
CRON OTHER WORK TYPE
Cam161E1- c Ji - Exterior (ofT e)
/3
DESIGNATED ADDRESS FLOOR OR APPATWENT
PROPERTY Manhattan /1/0 3
BOROUGH BLOCK L07 ZONING
DETAILED
DESCRIPTION Removal of debris (cleaning) from the collapse of the WTC
OF PROPOSED WORK from exterior building surfaces as per scope
Use back of form If necessary of work
previously reviewed and approved by NYCLPC.
COST OF PROJECT WARNING LETTER / NOV #
NIA
TENANT/LESSEE/ NAME. TITLE & FIRM (I applicablet PHONE (dart
CO-OP SHAREHOLDER
ADDRESS APT • CITY. STATE. DP CODE
NIA
ARCHITECT/ NAME. IRIS & FIRM (a applcoble)
ENGINEER
If applicable
ADDRESS CITY. STATE. ZIP CODE
Fiber Control, Inc. (516) 781-3000
CONTRACTOR NAME. TITLE & FIRM Of applicable) PHONE (day)
If applicable
3010 Burns Avenue Wantagh, New York 11793
ADDRESS CRY. STATE. ZIP CODE
PERSON FILING NYC Department of Environmental Protection (718) 595-3718
APPLICATION NAME. TITLE & FIRM W aodcpdel PHONE tdayl
e.g. Expeditor. Attorney,
Monoging Agent. etc. 59-17 Junction Boulevard, 8th Floor Corona New ynrk 11368
ADDRESS CITY. STATE. ZIP.ODE
ARE YOU APPLYING TO ANY OF THE FOLLOWING?
0 Buildings Department 0 City Planning Commission EJ Board of Standards & Appeals
lam the owner of the above listed property. I am familiar with the work proposed to be carried out on
my property and give my permission for this application to be filed. 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.
PhiV 7YV 6C c L/C
OWNERS NAME and TITLE (pleose type or Drkrt)
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PHONE (doYN
The owner is the Co-op Board or
Condominium Assodaeon. An officer of
the Co-op Board or Condominium COMPANY. CORPORA110N. ORGANIZATION (a applicoble)
As nns muse
t~ L/
Please Instructions oc Filing 7 iKlJaO A~ do - 2/37
for additional Wormetion. ADDRESS
NYC DEP for owner _ Z
SIGNATURE SIGNATURE OF OWNER OAtIT
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.
in. QM
NYC-WTC 000093995
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