NYC 9/11 Public Portal Document
THE CITY OF NEW YORK{ LANDMARKS PRESERVATION 'COMNIISSION , : .
fio . 1 CENTRE STREET. 9TH FLOOR, NEW YORK, NEW YORK,10007
• TEL: (212) 669- 7700 FAX: (212) 669-7960
APPLICATION FORM F2
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
Notice of Violation, please enter the number below.
Please print or type all items. If not applicable, mark N.A.
[Stat
DOCKET # DATE RECD DATE CERT. AS COMPLETE BLDG. DEPT. ♦ & DATE STAFF
0 INDMDUAL 0 SCENIC 0 INTERIOR
(Ph Of DESBNATION HISTORiC DISTRICT
PMW 0 CNE 0 C OF A 0 REPORT
ACTION 7 OTHER WORK TYPE
/ - aq vesi y sr
DWR y 4c'A ~T. ~~fic .55~'fiu~l.S%terior aF/ p4, )
ADDRESS FLOOR OR APARTMENT
DESIGNATED
PROPERTY Manhattan R7 LOT ZONING
BOROUGH BLOCK
DETAILED
DESCRIPTION Removal of debris (cleaning) from the collapse
P 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 id applicablet PHONE (day)
CO-OP SHAREHOLDER
ADDRESS APT # CRY. STATE. ZIP CODE
NIA
ARCHITECT/ NAME, TITLE & FIRM (if appllcabiat PHONE (dayl
ENGINEER
If applicable
ADDRESS CTY. STATE. ZIP CODE
Benjamin Kurzban and Son Control, Inc. (718) 531-2900
CONTRACTOR NAME, TITLE & FIRM (It oppiicoble) PHONE (day)
If applicable
1248 Ralph Avenue Brooklyn, New York 11236
ADDRESS CITY, STATE. ZIP CODE
PERSON FILING .NYC Department of Environmental Protection (718) 595-3718
APPLICATION NAME TITLE & FIRM (If applicable) PHONE (days
e.g. Expeditor, Attorney,
Managing Agent, etc. 59-17 Junction Boulevard, 8th Floor Corona NPw York 11368
ADDRESS CITY, STATE. ZIP IfOOE
ARE YOU APPLYING TO ANY OF THE FOLLOWING?
❑ Buildings Department ❑ City Planning Commission ❑ 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 t4LCHie C Sore eF,e ®, IRop ty Mo _ 2f2 -.571i35
'
cooperative or Condominium building, OWNER'S NAME and TITLE (please type or print PHONE (day)
the owner' Is the Coop Board or
Condominium Associallon. An officer of
the Co-op Board or Condominium COMPANY. CORPORATION, ORGANIZATION id oppllcoble)
Association must sign this application.
Please consult the Instructions for Filing 1.
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
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NYC-WTC 000094005
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