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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 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 /> Conditions (if any) .. . . <br /> .. .. .. . . . . . . . . . . . . ... .. . . . .. .. . . .. . . <br /> . .. . . .. . <br /> . . ..... ... ... .. ... . .. . ..... . ... ... . . <br /> . .. . . . .. .. . . . . . . . . . . .. . . . . . .... . .. .. <br /> . . . . .. . . . . . . . .. .. . .. . . ... . .. . . . <br /> Permit granted ( .. .. . .. .. . <br /> ) <br /> Yes or No <br /> Date .. . . . .. . . ... ... . 19. . . . <br /> r If permit was granted what other . .. ... . . . . . . .. .. . . .. . . .... . . .. . . . . . <br /> permits were issued by the Building <br /> Department? <br /> To Build? <br /> . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . <br /> �p 1 <br /> Use & Occupancy? . . . .. . . . .. . .. . .. . . . . . ... . . . . ' . . . . . .Board cf rlrp^a' s <br /> (Yes or No) (date) <br /> .r <br />