Land Use Review Application Supplemental Form PF {PF}

New York City Department of City Planning Land Use Application Supplemental Form Public Facility-Site Selection/Acquisition ...........PF 1. Requested action and proposed facility (Check all of the appropriate boxes.) Application No. a. ACTION REQUESTED: SITE SELECTION ACQUISITION b. PROPOSED FACILITY IS: EXISTING FACILITY NEW FACILITY EXPANSION If action involves selection and/or acquisition of an existing facility, how long has existing facility been at this location and what process was used to authorize use of site? If action involves a new facility, will it replace another facility located elsewhere? Yes No If yes, where is the other facility located and why is it being replaced? 2. Existing a. SITE IS conditions of proposed site 1) 2) IMPROVED CITY-OWNED* UNIMPROVED OWNED BY OTHER PUB. ENTITY PARTLY IMPROVED PRIVATELY-OWNED *Name of agency or other public entity having jurisdiction b. DESCRIBE EXISTING IMPROVEMENTS AND CURRENT USES ON THE SITE (If site is substantially vacant but has had uses within the past two years, briefly describe such uses and proceed to item 3.) 1) RESIDENTIAL USES ONSITE (Number of dwelling units) 2) COMMERCIAL USES ONSITE (Number of firms) 3) MANUFACTURING USES (Number of firms) 4) WILL DISPLACEMENT\RELOC. OF ABOVE USES BE REQ'D? (Total commercial employees) (Total manufacturing employees) NO YES If yes, describe below: 3. Proposed facility a. b. c. d. SITE AREA FLOOR AREA ZONING USE GROUP CAPITAL BUDGET LINE FY NUMBER OF EMPLOYEES (main shift): Working: On-site OTHER SHIFTS AND NUMBER OF EMPLOYEES: NUMBER AND TYPE OF FACILITY VEHICLES: On-site No. OF ACCESSORY PARKING SPACES TO BE PROVIDED: SHIFT: Off-site Hours/days Off-site Location 4. Fair Share On-site Off-site YES Location a. b. c. IS PROJECT SUBJECT TO FAIR SHARE CRITERIA? IF NOT, PLEASE EXPLAIN: IS PROJECT LISTED IN STATEMENT OF NEEDS? NO NO YES FY DID BOROUGH PRESIDENT PROPOSE ALTERNATE SITE PURSUANT TO CHARTER SECTION 204(f) or (g)? NO IF YES, WHAT SITE? YES d. pf 0505 pdf INDICATE TYPE OF FACILITY: LOCAL/NEIGHBORHOOD REGIONAL/CITYWIDE American LegalNet, Inc. www.FormsWorkflow.com