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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 reguiations, LHDC Natue of Applicant blo bilge bord, layPayantaNI nOK Address of Applicant Applicant Phone No, aan lize jens Lid) cory hyo [ory Oye Applicant’s Email Role of Applicant to Project (owner, attorney, lessee, agent, architect, engineer, contractor...) Property Owner: NAME: LHD C Address: So Ese. Loa Lackayeane V Y lig | Director of Development