NYC 9/11 Public Portal Document
THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSIONa3, ;, R
yap , 1 CENTRE STREET, 9TH FLOOR, NEW YORK, NEW YORK, 10007
TEL: (212) 669- 7700 FAX: (212) 669-7960
APPLICATION FORM
FOR WORK ON DESIGNATED PROPERTIES
F2
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 toe Warning Letter or
Notice ofViolation. please enter the number below.
Please print or type all items. If not applicable, mark N.A.
C DOCKET 0 DATE RECD DATE CERT. AS COMPLETE SLOG. DEPT. ♦ & DATE STAFF
0 INDMDUAL 0 SCENIC Cl INTERIOR
PMW ❑ CNE U C OF A ❑ REPORT
ACTION OTHER WORK TWE
12 LT c I-1 STR6tT Exterior t2aof- )
ADDRESS FLooa aR AAeRTM1ENT
DESIGNATED
PROPERTY Manhattan q I (2-
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.
)cP-~~
R L
COST OF PROJECT WARNING LETTER / NOV #
NIA
TENANT/LESSEE/ NAME. TITLE & FIRM (It applicable) PHONE (cloy)
CO-OP SHAREHOLDER
ADDRESS APT • M. STATE. ZIP CODE
NIA
ARCHITECT/ NAME. TITLE & FIRM lit applicable) PHONE ickM
ENGINEER
If applicable
ADDRESS CITY., STATE. ZIP CODE
Benjamin Kurzban and Son Control, Inc. (718) 531-2900
CONTRACTOR NAME. TITLE & FIRM (If applicable) PHONE (Coy)
If applicable
1248 Ralph Avenue Brooklyn, New York 11236
ADDRESS CITY, STATE. ZIP COCA
PERSON FILING NYC Department of Environmental Protection (718) 595-3718
APPLICATION NAME. TITLE & FIRM (It aod,cabiel PHONE (doyl
e.g. Expeditor. Attorney,
Monoging Agent, etc. 59-17 J_ unction Boulevard, 8th_Fll _r __C_arona ( Newyork 11368
ADDRESS CITY STATE.
ARE YOU APPLYING TO ANY OF THE FOLLOWING?
❑ Buildings Department LI 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 tit a
cooperative or condominium building.
G E3 LL r C> t T C ( t f ar i 1 = Le-E
OWNER'S NAME and TIRE (pleoso type or print)
L t~
~', it 2.,
233
PHONE (dovi
I
the 'owner is the Co-op Board or
Condominium Association. An officer 01 kf ~ t :. \ \' s~ _
the Co-op Board or Coedorn(nhun COMPANY• CORPORATION• ORGANIZATION IS applicable)
Association must sign 1hls epplor Fill .
Please consult the Inatru is ap for Filing 4 `
_t-t t~
___ ~ ~ t t_ l t L-L t T CL 1 C C Ci N t (1{~ {_ N. ( L ',
for additional information. ADTRRESS-- — -- --- -`--- - L
NYC DEP for owner
SIGNATURE GNATUTTI of owNER
SI DAn
Note Section 25-317 of the Administrative Code of the City of New 1'nik makes It a punishable offense to willfully make false statements on this application
NYC-WTC 000094029
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