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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. Sry (chen J ; pm. Name of Applicant “signature or Applicant Applicant Phone No. (POpe He LOO One Applicant’s Email — Role of Applicant to Project (owner, attorney, lessee, agent, architect, engineer, contractor...) Property Owner: NAME: 2839 Soul Pate Pene LEE Address Director of Development