Department of Buildings Permit Application Form, date unknown

NYC 9/11 Public Portal Document J

Statements and Signatures______________ ■ Applicant’s SlatRmenlS ah applicants must complete and sign below Owner's Statements I prepared or supervised the preparation of the plans and specifications herewith X submitted and to the best of my knowledge and belief, th© plans and work shown X I have authorized the applicant to file this application for the work specified herein and all future amendments. thereon comply with the provisionsof the Building Codeand other applicable laws and regulations, Owner's CerTification Regarding Occupied Housing Accommod^iions except as set forth in the accompanying documents. The building to be altered, or the site of the new building, or the dwelling to be demolished or removed, as the case may be, contains occupied housing Tract Housing Statement complete il applicable and sign below accommodations subject to control under Chapters of Title 26 of the Administrative Code. Reference Job Number

I hereby state that all specifications relating to this job are identical to those previouslyfiled under the above referenced job number, except as sped tied herein. j Yes lx I The owner has notified DHCR of his intention to (file such plans/apply for such Applicant permit) and has complied with all requirements imposed by the regulations of such agency as preconditions for such (filing/application). I acknowledge that I have read and complied with ^instructions pertaining to this

X Name application and supiUomenatry schedules submj^ted.

NQRMA^ Date 6/16/92 DE lx I NO Date DHCR notified:

Signatu^ ------- Fee Exemption Request Statement In accordance with 26-210 of the New York City Building Code I hereby state that the proposed work involves a building or property used exclusively for the Seal(P.E.of R.A.) purposes indicated in such section.

Owner Type of Ownership Non-Profit I Individual Corporation XI Government

Last Name First Name ”m?g

SILVERSTEIN JAY Title PRES. Business Name/Agency FIRST BOSTON CCtftP. / Address 5 WORLD TRADE CENTER City NEW YORK State NY 10048 Phone( 212* 322 7092 Vs Name of Signator JAY SILVERSTEIN V\ Relationship to Building Owner PARTNER

13 iL'Zr

l/yorpfcration, name of second officer Last Name First Name MJ.

Palsification of any statement is a misdemeanor under Section 26-124 of the Title

Administrative Code and is punishable by a fine or imprisonment, or both. Address

it is unlawful Io give to a city employee, or for a city employee to accept, any benefit. City mooetaryor otherwise, either as a gratuity for proper ly per forming the job or in exchange State ZIP Phone( ) fr>r special consideration. Violation is punishable by imprisonment or fine or both.

Internal Use _________________ Applicalion Complete (or Filing and Fee Estimation Approvals Amount Due Examined and Recommended lor Approval Cost Est'mate(lf different from applicant) Approved lor | | Foundation I Earthwork Only r«e*Filer Name Examiner Name

Date Examiner Signature Date

Initt.il Amount Paid Limitation(s): (To appear on permit)

Vesified Oy Date

Balance Paid

Verified By Date

Stamps and Certifications: Other Approvals Examiner Name

Examiner Signature Date

Approved Borough Superintendent Signature Date

Revised t-90 FW-1 Page .

NYC-WTC_000166096