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SPECIAL PERMIT Date ..........................._-- 19...... <br /> File ... .......................... To Building Inspector; <br /> You are hereby authorized to issue a <br /> APPLICATION for SPECIAL PERMIT "Special Permit" for this application for <br /> signature of the Board of Appeals and are <br /> hereby advised that this application has <br /> received the approval of the Board of <br /> Appeals. <br /> ....................................................................................... <br /> Name If any conditions are written below, you <br /> are requested to see that they are complied <br /> with, and included in permit. <br /> .. ............... _....... ................_........................................... <br /> Location <br /> Conditions (if any) ....................... .............. <br /> ....................................................................................... <br /> ....................................................................................... <br /> .............................................. ................. ............ <br /> ....................................................................................... <br /> ............................................................a..................... <br /> ... . <br /> ............................................................................ <br /> ......................................................:...................... <br /> ........ . <br /> ....................................................................................... <br /> Permit granted (....................) <br /> Yes or No <br /> ....................................................................................... <br /> 4 <br /> .(^ Date .................... ...... 19...... . ..................................................................................... <br /> C <br /> C� et <br /> If permit was granted what other permits <br /> were issued by the Building Dept? .................... ............................................... <br /> ToBuild? .............................. .............................. <br /> .................................................................... <br /> (Yes or No) (date) <br /> Use & occupancy? .............................._................... .........................._........................... ....... ... <br /> (Yes or No) (date) Board of Appeals <br />