PUBLIC DESIGN COMMISSION OF THE CITY OF NEW YORK APPLICATION FORM CERTIFICATE FILE EXHIBIT Do not write above this line. THE DESIGN COMMISSION reviews permanent (defined as one year or more) structures, both public and private, as well as works of art that are proposed on or over City-owned property, including property that is leased by the City to another entity. All projects must be listed on the transmittal of the appropriate agency(ies), and all submission materials must be submitted on the deadline and include a Landmarks Preservation Commission advisory report, if applicable. Incomplete and/or late submissions will not be calendared. Each type of proposal has general and specific submission requirements. Additional information may be requested. Submission Guidelines and a Calendar of Meetings, including Submission Deadlines, are available at www.nyc.gov/designcommission. CHECK THE CATEGORY THAT BEST DESCRIBES YOUR PROJECT: Structure Newsstand Park or Open Space Signage Streetscape Artwork: Percent for Art Distinctive Sidewalk and/or Light Artwork: Gift Fixtures Artwork Relocation and/or Conservation PROJECT TITLE, INCLUDING LOCATION/FULL STREET ADDRESS: Please attach a brief statement that describes the project scope (see Submission Guidelines). CITY COUNCIL DISTRICT(S) #: __________ COMMUNITY BOARD DISTRICT(S) #: ___________ Date(s) of Community Board review(s): ________________________________________________ Please attach the Community Board(s) resolution(s). ESTIMATED PROJECT COST: ______________________________________________________ CHECK THE DESIGN COMMISSION ACTION REQUESTED: Courtesy Review Preliminary Review Advisory Review Final Review Conceptual Review Preliminary and Final Review Page 1/2 American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION FORM PERCENT FOR ART: Indicate whether this project has an associated Percent for Art component. Yes No N/A (the primary application is a Percent for Art project) Please note that for all structures, parks, open spaces, and streetscape projects, the Percent for Art component should be submitted for conceptual review when the project is submitted for preliminary review. TREES: Total number of new trees: _____________ Total number of tree removals: ____________ Please attach documentation of Division of Forestry, Horticulture and Natural Resources Group approval, if applicable. DISTINCTIVE SIDEWALKS: Please attach a copy of the Builder's Paving Permit receipt from the Department of Transportation or Department of Buildings. ARCHITECT, LANDSCAPE ARCHITECT, ARTIST, ENGINEER, DESIGNER OR CONSERVATOR: Name Firm Address City, State, Zip Code Telephone, Fax, Email OWNER OF PRIVATE STRUCTURE OR DESIGNATED REPRESENTATIVE, IF APPLICABLE: Signature Name Address City, State, Zip Code Telephone, Fax, Email COMMISSIONER OR DESIGNATED REPRESENTATIVE OF CITY AGENCY WITH JURISDICTION OVER PROPERTY: Signature Name Title Agency If two or more agencies share jurisdiction, signatures for each agency's representative should be attached. Date Date Page 2/2 American LegalNet, Inc. www.FormsWorkFlow.com