NYC 9/11 Public Portal Document
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THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION ` ". • `' ' :
• a0 I COME STREET, 9TH FLOOR, NEW YORK, NEW YORK,10007 .
TEL: (212) 669- 7700 FAX: (212)669-7960
APPLICATION FORM
FOR WORK ON DESIGNATED PROPERTIES
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This application will not be deemed complete until It is so certified by the Landmarks
Preservation Commission. An application consists of a application teEm and the materials
necessary to describe the project fully. If being submitted in response to a Warning Letterer
Notice of Violation, please enter the number below.
Please print or type all Items. If not applicable, mark NA
1510ff Lion
PC DOCKET • DATE RECID DATE CERT. AS COMPLETE BLDG. DEPT. • & DATE STAFF
❑ INDMD(aj 0 SCENIC Cl INTERIOR
,YPE OF UESIondA11ON HISTORIC DISTRICT
PMW Cl CNE Cl C OF A Cl REPORT Cl
ACTION OTHER WORK TYPE
/ô'/ P,Pi - Exterior (fooF)
DESIGNATED ADDS FLOOR OR APARTMENT
PROPERTY Manhattan lyre 75'O3
BOROUGH BLOCK LOT ZONING
DETAILED
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 & FIRM (n applicable) PHONE (dart
CO-OP SHAREHOLDER
ADDRESS APT r CITY. STATE ZIP COOS
NIA
ARCHITECT/ NAME TITLE & FIRM ti applicable) PHONE (dart
ENGINEER
If applicable
ADDRESS CITY. STATE. ZIP CODE
Fiber Control, Inc. (516) 781-3000 1
CONTRACTOR NAME. TITLE & FIRM Of apdicob.u) PROW (day)
If applicable
3010 Burns Avenue Wantagh, New York 11793
ADDRESS CITY, STATE, ZIP CODE
PERSON FILING NYC Department of Environmental Protection (718) 595-3718
APPLICATION NAME. TITLE & FIRM (I applicable) PHONE (day)
e.g. Expeditor. Attorney.
Managing Agent, etc. 59-17 Junction Boulevard, 8th Floor Corona NPw York 11368
ADDRESS CITY. STALE. 21P.
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. lam 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 /off' £4ee A5-y -c,AJ2eS 2 /-? - `/0 6- 5.57y
cooperative or condominium lou". OWNERS NAME and TITLE (please type of print( PHONE (day)
the •owner Is the Cr op Board or
Condomink,m Assoclalion. An ofrxer of
We Co-op Board or Condominium
Association must sign this application
Please consub the Instructions for Fdmg 01 w Y e, ill y /oa/3.3aiy/
for addllonat Information
DEP
SIGNATURE
Note: Section 25-317 of the Administrative Code of the City of Now York makes it a punishable offense to wdtfully make false statements on this eppkcation.
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NYC-WTC 000093998
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