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APPLICATION IS HEREBY MADE to the City of Lackawanna Planning and Development Board for a sito 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 reguiations, LHOC Name of Applicant ignature Of App b4o Ale Croll LarF-awante NY lA Address tlh Applicant Phone No, sanljewstid |. Owhes ligant’s Edlhleory Role of Applicant to Project (owner, attorney, lessee, agent, architect, engineer, contractor...) Property Owner: name, HEYC Address: bio KKile. Loa labauann, NI dS - Diractor of Development