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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 Lackawenna. The applicant hereby agrees to comply with all applicable laws, rutes, ordinances and regulations. LADc Nate of Applioant Signature of Applicant bo Lily bord, La Payaan Ny HLS Address of Applicant Applicant Phone No, Ae dyzejens Pid) IHdeorp wh\/.o whyory Owes Applicant’s Email Role of Applicant to Project (owner, attorney, lessee, agent, architest, engineer, contractor...) Property Owner: wameLHDC Address: suo Bile. fonk . Lacbawanna V y nm = Director of Development