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SPECIAL PERMIT Date . . .. . . .. . .. .19. . . . <br /> File . .. .. .. . . To Building Inspector <br /> i 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 /> this 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 /> O <br /> Conditions (if any) . . ... . . . . . .. . . . <br /> .. .. .. .. .. . . . .. .. . .. . .. . . ... . .. . . <br /> � • .. .. . .. . . . .. .. .. . . . . . . .. .. .. . . .. .•'tip • . ... . .. .. . .. . ... . .. .. .. . . . . .. . . .. • it <br /> _ • <br /> . . .. . . .. .. . . . . . . . . . . . . . . . . . . . . . . . <br /> Permit granted ( . .. . . . . . . ) <br /> Yes or No <br /> . . .. .. . . .. . . . . . .. . . . . . . . . . . . . . .. . . . <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 /> _r <br /> Use & Occupancy? . . . . . .Board ofAppeals. . .. .. . . . . .. . . <br /> - (Yes or No) (date) <br />