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SPECIAL P'LRMIT Date . . . . . . .. . . . . .19- _ <br /> File .. . .. .. . . To Building Inspector <br /> Application for Special Permit You are hereby authorized to issue <br /> a "Special Permit' for this applica- <br /> tion for signature of the Board of <br /> Appeals and are hereby advised that <br /> th-is application has received the <br /> approval of the Board of Appeals. <br /> Name <br /> If any conditions are written below <br /> .. , . . you are requested to see that they <br /> Location are complied with, and included in <br /> permit. <br /> . .. ... .. .. . . .. .. .. . . ........ .. .. . .. . <br /> . ... . . . . .. .. . .. . .. . .. . .. . . ... .. . .. .. <br /> Conditions (if any) .. .. . . .. .. . . .. . <br /> . . . . .. . . . . . . .. . . . . . . . . . .. . . . .. . . . . . . <br /> . . .... . . . . ... . . .. . . . . . .... . . . . ... . . <br /> . . . . . . .. . . . . . . . . . .. . . . . .. . . . . .. ... . <br /> Permit granted ( . . . . .. .. . . <br /> ) <br /> Yesor No . . .. . . . .. . . . . . .. . . . . . . .. . . . . . . . . . . . <br /> Date .. . . . . . . . .. . . . . .19. . . . . . .. . . . . . . . .. . . . . . .. . . . . . . . . . . . . . . . <br /> If permit was granted what other . . . .. . .. . . .. . . . . . . .. . . .. . . . . . . • •• • • <br /> _ A permits were issued by the Building <br /> Department? <br /> To Build? . . .. . . .. . . . . . . . . . ... .. . . . . . . . . . . . . . <br /> (Yes or Ne) (date) . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . <br /> Use & Occupancy? . . . . . . . .. . . . . . .. . . . . . . . . . . .. . . .. . .Board of Appeals <br /> (Yes or No) (date) pp <br />