NYC 9/11 Public Portal Document
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r ' THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION' ~+'
I CENIRE•STREEZ 9TH FLOG NEW YO NEW YO 10007 ;* t
7M. :(217) 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 an application form and the materials i.
necessary to describe the project fully. If being submitted in response to a Warning Letter or
Notice of Violation, please enter the numberbelow.
Please print or type all items. If not applicable, mark N.A.
PC DOCKET f DATE RECD DATE CERT. AS COMPLETE BLDG. DEPT. # & DATE STAFF
0 INDIVIDUAL 0 SCENIC 0 INTERIOR
OF DE51WNAN HISTORIc DISTRICT
PMW ❑ CNE p car A p REPORT
(ACTION OTHER WORK TYPE
f4D0
6 7 C7 (2EEN rAI IC I—i STREET Exterior — C
DESIGNATED ADDRES FLOOR OR APARTMAEM
Q
PROPERTY Manhattan 1 { 1 1
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 (it opplicablel PHONE (doyl
CO-OP SHAREHOLDER
ADDRESS APT a CRY. STATE, ZIP CODE
NIA
ARCHITECT/ NAME, TITLE & FIRM Of applicable) PHONE Idayl
ENGINEER
If applicable
ADDRESS CITY. STATE, ZIP CODE
Trio Asbestos Removal Corp. (718) 961-4100
CONTRACTOR NAME, TITLE & FIRM (If applicable) PHONE (ooy)
If applicable 14-20 129 Street College Point, New York 11356
ADDRESS CITY. STATE, ZIP CODE
PERSON FILING NYC Department of Environmental Protection (718) 595-3718
APPLICATION NAME. TITLE & FIRM (it applicable) PHONE (day)
e.g Expeditor Attorney.
Managing Agent, etc. 59-17 Junction Boulevard, 8th Floor Cor_ona _N.ew_.ork 11368
AE7DRE55 CITY. STATE. ZIP Cxy
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 riled. The information entered is correct
and complete, to the best of my knowledge.
OWNER
For applications for work on or in a M~~ .S ~iucssE Z ( 2.1 7?3"7 SR3z
cooperative or condominium building, OWNERS NAME and TITLE (please type or pant) -- PHONE (day)
the 'owner' is the Co-op Board or
Condominam Association. An officer of cc-7 ac \C~ \ wC
the Co-op Board or Condominium PANY, CORPORATION. ORGANIZATION if applicable)
Association roust sign this application
Please consult the instructions for Filing
for additional Information
Y l 1Z PEA 1rCZ A ~l i.~—S7~T AT
J. N, l 2 tl
NYC DEP for owner
SIGNATURE SIGNATURE OF OWNER DATE
Note Section 25-317 01 11,0 Administrative Code of the City 01 Now York makes it a punishable offense 16 willfully make false statements on this application
NYC-WTC 000094026
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