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Petitioner Name Petitioner Name

Petitioner Name - PDF document

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Uploaded On 2015-10-13

Petitioner Name - PPT Presentation

Address Telephone Email Fax Telephone Email Fax eg attorney engineer or architect EIN Contract Manager Contact Person A ddress A ddress CONTACT INFORMATION Date of Submission person who will hand ID: 159000

Address Telephone Email Fax Telephone Email Fax e.g. attorney engineer architect EIN

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Petitioner Name Address Telephone Email Fax Telephone Email Fax e.g. attorney, engineer or architect EIN # Contract Manager Contact Person A ddress A ddress CONTACT INFORMATION Date of Submission person who will handle payments to the City, insurance and security deposit after the consent is granted The Petitioner will use the requested structure for the following purpose The Petitioner requests a revocable consent from DOT to construct, maintain and use Petitioner must submit photos of existing conditions for above ground structures whether subject structures are in place or not. PETITION DETAILS Additional information, if any Petition Form For A New Revocable Consent New York City Department Of Transportation Division Of Franchises, Concessions And Consents RC-1. Revised 05/27/10 55 Water Street, 9th Floor New York, NY 10041 PROPERTY INFORMATION submit copy of deed Check one. Owned by the Petitioner Leased by the Petitioner submit consent of owner, and copies of deed and lease Address Address Block and lot Owner Block and lot Owner If only one property, indicate N/A for second property. If more than two, attach additional information. Community Board City Council Member Nature of Petitioner’s Business PETITIONER INFORMATION a domestic corporation incorporated in the State of New York authorized to do business in the State of New York a general partnership an individual other, describe The Petitioner is appropriate seal. Petition Form For A New Revocable Consent New York City Department Of Transportation Division Of Franchises, Concessions And Consents RC-1. Revised 05/27/10 55 Water Street, 9th Floor New York, NY 10041 WHEREFORE, will before 10 days prior to any and all such due dates, request from the Department in writing, an extension terms and conditions are not met, the Department will, without further notice, void the petition. If a petition is voided, a new petition must be submitted along with the required petition fee. Petitioner acknowledges that the Department may, in its sole discretion, allow exceptions to the requirements contained in this paragraph. Signature WHEREFORE, Petitioner respectfully requests that the revocable consent be granted as aforesaid. Subscribed and sworn to before me this day of , 20 . Notary Public Petitioner covenants that the revocable consent, if granted, will be for the private use of the petitioner. 1. 2. been fully paid. of two newspapers to inform the public of the hearing on agreement terms. Hearings are held pursuant to 4. jurisdiction, the petitioner will submit all necessary materials and make a presentation to the Public Design 5. of two newspapers to inform the public of the hearing on agreement terms. Hearings are held pursuant to within 15 days of its receipt. Failure to do so may result in denial of consent. Petitioner acknowledges that the �nal agreement will include provisions for yearly compensation to the City, 7. items are due. PETITIONER AGREES TO THE FOLLOWING TERMS OF PETITION ACCEPTANCE BY DOT Print Name of Signatory Print Title of Signatory By Petition Form For A New Revocable Consent New York City Department Of Transportation Division Of Franchises, Concessions And Consents RC-1. Revised 05/27/10 55 Water Street, 9th Floor New York, NY 10041