NYC 9/11 Public Portal Document
THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION
I CENTRE STREET, 9TH FLOOR, NEW YORK, NEW YORK, 10007;
TEL: (212)669-7700 FAX: (212) 669-7960
APPLICATION FORM
FOR WORK ON DESIGNATED PROPERTIES
Fz
This application will not be deemed complete until it Is so certified by the Landmarks
Preservation Commission. An application consists of an Fpplication form and the materials
necessary to describe the project fully. If 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
FC DOCKET is DAME RECD DATE CERT. AS COMPLETE BLDG. DEPt is & DATE STAFF
❑ INDPnDUAL O SCENIC 0 NTERK~R
PMW O CNE CI C OF A 0 REPORT CI
TION OTHER WORK TYPE
5l Nap-Rd V .57A
- i Exterior C.KOOF+ CAl
DESIGNATED "DD's ROOK OR AA,RR.@fT
PPOPERTY Manhattan /33
BOROUGH BLOCK LOT ZONING
DETAILED
Removal of debris (cleaning)
) from the collapse of the WTC
OT PROPOSED WORK from exterior building surfaces as per
Use back of form if necessary scope of work
previously reviewed and approved by NYCLPC.
COST OF PROJECT WARNING LETTER / NOV #
NIA
TENANT/LESSEE/ NAME 1171.E & FIRM (e opdicoblel PHONE loa
CO-OP SHAREHOLDER
ADDRESS APT A CITY STATE, ZIP CODE
NIA
ARCHITECT/ NAME TIRE & FIRM (It opdbable) PHONE tdoy(
ENGINEER
If applicable
ADDRESS CITY, STATE ZIP CODE
Fiber Control, Inc. (516) 781-3000
CONTRACTOR NAME TIRE & FIRM (If opplcabla) PHONE (dopj
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 (11 OPo fCobiel PHONE IOWA
e.g. Expeditor, Attorney.
Managing Agent, etc. 59-17 Junction Boulevard, 8th Floor Corona NPw Ynrk 11368
ADDRESS CAN. STATE. ZIP ODE
ARE YOU APPLYING TO ANY OF THE FOLLOWING?
0 Buildings Department 0 City Planning Commission El 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
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.
5/ Urnreb ( 2I
OWNERS NAME and TITLE (dense type or peril
21z -96 L J1?S'9
PHONE (Carl
the 'owner' is the Coop 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.
A- cv.
NYC-WTC 000094003
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