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Appeals (A) Calendar Application Form - New York
| Appeals (A) Calendar Application Form Form. This is a New York form and can be used in Board Of Standards And Appeals City Of New York New York Local County . |
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City of New York Board of Standards and Appeals 40 Rector Street, 9th Floor New York, NY 10006-1705 Phone: (212) 788-8500 Fax: (212) 788-8769 Section A Applicant/ Owner _______________________________________________ NAME OF APPLICANT _______________________________________________ ADDRESS _______________________________________________ CITY STATE ZIP _______________________________________________ AREA CODE TELEPHONE _______________________________________________ AREA CODE FAX _______________________________________________ EMAIL Section B Site Data Appeals (A) Calendar Application Form BSA APPLICATION NO._______________________ _______________________________________________ OWNER OF RECORD _______________________________________________ ADDRESS _______________________________________________ CITY STATE ZIP _______________________________________________ LESSEE / CONTRACT VENDEE _______________________________________________ ADDRESS _______________________________________________ CITY STATE ZIP ______________________________________________________________________________ STREET ADDRESS (INCLUDE ANY A/K/A) ____________________________________________________________________________________________________________________ DESCRIPTION OF PROPERTY BY BOUNDING OR CROSS STREETS _______ BLOCK __________ LOT(S) _______________ BOROUGH ______________________ _______________________________ COMMUNITY DISTRICT NO. CERTIFICATE OF OCCUPANCY NO. . ____________________________________ ______________________________ EXISTING ZONING DISTRICT ZONING MAP NUMBER (include special zoning district, if any) All sections must be completed __________________________ CITY COUNCILMEMBER Section C Decision Appeal Application is made from a decision of the: DATED______________________________ (LEGALIZATION YES NO FIRE DEPARTMENT DEPARTMENT OF BUILDINGS OTHER ACTING ON APPLICATION NO._____________________________________ Section D Description IN PART ) Section E BSA History and Related Actions If "YES" to any of the below questions, please explain in the STATEMENT OF FACTS Has the premises been the subject of any previous BSA application(s)?............................................. PRIOR BSA APPLICATION NO(S): ____________________________________ Are there any applications concerning the premises pending before any other government agency? Is the premises the subject of any court action?............................................................................... YES NO I HEREBY AFFIRM THAT BASED ON INFORMATION AND BELIEF, THE ABOVE STATEMENTS AND THE STATEMENTS CONTAINED IN THE PAPERS ARE TRUE SWORN TO ME THIS _____ DAY OF ___________ 20___ _______________________________________________________________ Signature of Applicant, Corporate Officer or Other Authorized Representative __________________________ Print Name ________________________ _______ Title NOTARY PUBLIC American LegalNet, Inc. www.FormsWorkflow.com
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