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APPLICATION IS HEREBY MADE to the City of Lackawanna Planning and Development Board for -a site plan review, special use permit, development plan review or subdivision review as required by the Municipal Code of the City of Lackawanna. The applicant hereby agrees to comply with all applicable laws, rules, ordinances and regulations. ann Of US Yy Rnre Name of Applicant ignature Of Applican Tess OL Applicant Phone No, = = Role of Applicant to Project (owner, attorney, lessee, agent, architect, engineer, contractor...) Property Owner: name: VY\ af tba Our Address: Director of Development