NYC 9/11 Public Portal Document
THE CITY OF NEW YORK LANDMARKS PRESERVATION COMMISSION
~ONGi p I CENTRE STRE1 ET, 9TH FLOOR, NEW YORK, NEW YORK, 10007
TEL: (212) 669- 7700 FAX: (212) 669-7960
APPLICATION FORM ~2 -
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 ofViolation, please enter the number below.
Please print or type all items. If not applicable, mark N.A.
G 1e.au y ..SL. C 'A 4$ t 'P")Exterior — C o° f..)
S FLOOR ORAPARTAEM
DESIGNATED
PROPERTY Manhattan 2 -9 75 O 1
BOROUGH BLOCK lot ZONING
DETAILED
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 a Fr2M (K appdaaael PHONE (day)
CO-OP SHAREHOLDER
ADDRESS APT ,s CRY ATE. ZIP CODE
NIA
ARCHITECT/ NAME, TITLE & FIRM (K oppNaobb) PHONE idoy)
ENGINEER
If applicable
bOl SS CRYsL4 W CCIX
Trio Asbestos Removal Corp. (718) 961-4100
CONTRACTOR NAME. TITLE & FIRM Itt oppBaoblei PHONE tic 1
If applicable 14-20 129 Street College point, New York 11356
ADDRESS CITY. SLAJE, Z COOK
PERSON FILING NYC Department of Environmental Protection (718) 595-3718
APPLICATION NAME, TITLE a FIRM (K OpPk)ot e) PHONE (day t
e.g. Expeditor, Anomey,
Managing Agent, etc. 59-17 Junction Boulevard, 8th Floor gonATEei ~w
Ne Ynrk 11368
AOceESS
ARE YOU APPLYING TO ANY OF THE FOLLOWING?
0 Buildings Department 0 City Planning Commission 0 Board of Standards & Appeals
lam the owner of the above listed property. tam 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
Forapplicaaonsforwodton Orin a ~' • 12 A 3)H P KP_1SH~3 A-J rfj IR C7at„.
moperathn or Condominium budding, 4,pm.IEWS NAFiE and TITLE (please type or rk*) Nail
In. 'own r" is the Co-op Board or
Condominium Aaaociatlon. An otBwr of
the Co-op Bond or CondornMWm COMPAf CORPORATION, ORGANIZATION (r opplicoblal
Assocbibn must sign this aplIkotbn.
Please consult the InstructIons tot FEk10
for additional information.
NYC DEP fle for owner
SIGNATURE SG#ATWIE OF OWNER GATE
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 applcation.
an. aoo
NYC-WTC-000118955
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