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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. LHDC hh Name of Applioant Signature of Applic ress of Applicant pplicant Phone No. ek! jews Lith deorpuny on | Oke Applicant’s Email Role of Applicant to Project (owner, attorney, lessee, agent, architect, engineer, contractor...) Property Owner’ NAME; LH ) i i, Addtess: Wo lfpe al Latasanne,tN , U2 Diractor of Development