Land Use Review Application Supplemental Form ZS ZA ZC {ZS ZA ZC}

New York City Department of City Planning Land Use Review Application Supplemental Form Special Permit/Authorization/Certification. . . .ZS/ZA/ZC APPLICATION NO. APPLICATION NO. APPLICATION NO. (If more than five actions are being requested, enter "see attached" below, and list ALL PROPOSED ACTIONS in the same format as below on a separate sheet titled "Proposed Zoning Special Permits/ Authorization/ Certifications.") Special Permit (ZS) Authorization (ZA) Action(s) requested pursuant to ZR (Check one box for each proposed action) Certification (ZC) PURSUANT TO: ZONING RESOLUTION SECTION NUMBER ZONING RESOLUTION SECTION TITLE TO MODIFY: SECTION NO. (If applicable) HAS A DRAFT RESTRICTIVE DECLARATION BEEN INCLUDED WITH THIS APPLICATION? WILL ALL PARTIES IN INTEREST TO THE PROPERTY AGREE TO A RESTRICTIVE DECLARATION IF REQUIRED? YES YES NO NO Property ownership/ interest CHECK APPLICABLE BOX(ES) (If more than one box is checked in the left column, please explain below). APPLICANT: IS OWNER OF SUBJECT PROPERTY IS LESSEE OF SUBJECT PROPERTY HAS CONTRACT TO LEASE/BUY SUBJECT PROPERTY APPLICANT: IS A CITY AGENCY IS A STATE OR FEDERAL AGENCY IS OTHER (explain real property interest below) Discussion of findings STATEMENT IN SUPPORT OF REQUIRED ZONING RESOLUTION FINDINGS/DECLARATION OF COMPLIANCE (This is the same discussion/statement as in Attachment #11. If it fits below, it may be put here instead of in a separate attachment. If Attachment #11 has been completed, you may leave this area blank). sac 0505 pdf American LegalNet, Inc. www.FormsWorkflow.com