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SPECIAL PERNIf 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 /> .. . . .. . . . . . . . . . . . . . . . . . . .. .. .. . ... . . . .. .. ........ . . . . ... .. . ... . .. . ., . . .1 <br /> . . ... . ... . . . . . . . . . . .. ... .. . . .. . . . . . <br /> . . . .. .. . . . . . . <br /> Permit granted ( . . .. . ... ) <br /> i \.fix <br /> Yesor No .. . . . . . . .. . . . . . . . .. ... . ...... . .. . . . <br /> j. Date .. .. . .. . . . . . .. . .19. .. . . . . . .. . . . . . . . . .. . . .. . .. ...... . . . , . . <br /> . . ... . . . . . . . . . . .. . .. . . .. ... . .. . . . . . <br /> } If permit was granted what other • • •• ••• •• • • . . . . . . .... . .. . . .. . . . . .. . <br /> '•t ,._. permits were issued by the Building <br /> Department? <br /> . . .. . . . . . . . . . . . . . . . . . . .. .. . . . . . . . . . <br /> To Build? . . . . .. . .. . . ... .. . .. . ... <br /> (Yes or Ne) (date) . . .. . . . .. . . .. . . . . . . . . . . . . . .. . .. .... ­ <br /> Use & Occupancy? . ... . . Board of. . . . .. . ... . .. . . . . . Appeals. . . . - <br /> (Yes or No) (date) <br />