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SPECIAL PERMIT 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 ofe the Board of <br /> Appeals and are herek� advised that <br /> this application ham�rreceived the <br /> . .. . . approval of the BoayZ 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 /> Permit granted ( . . . . . . .. . . <br /> ) <br /> Yesor No . . .. .. . . . . .. . . . . . . . .. . .. . . . .. . . . . . . <br /> Date .. .. .. . . . . ... . . .19. . . . . .. . . . ... . . <br /> . . .. . . . .. . .. . . .. . . . . . . . .. <br /> Ifpermit was granted what other . . .. . . .. . . . ... . . .. . .. . ... . . . . . . . . . . <br /> permits were issued by the Building <br /> Department? <br /> . . ... . .. . . . . . . .. . .. . . . . . . . . . .. .. . . . <br /> To Build? . . . . . . . .. . . .. .. . . .. . ... <br /> (Yes or No) (date) . . .. . . . .. . . .. . .. . . . .. .. ... . .. . . . . . . <br /> Use & Occupancy? . . .. . . .... . . . . .. . . .. . . . .. . .. . .. <br /> . (Yes or No) (date) Board of Appeals <br />