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<br /> SPECIAL PERMIT Date . . .. . . . .. . . ..19. . . .
<br /> File . .. .. . . . . To Building Inspector
<br /> Application for Special Permit You are hereby authorid to issue
<br /> a "Special Permit' for this applica-
<br /> tion for signature of the Board of
<br /> Appeals and ttare hereby-advised that
<br /> this applica.;ion has• rereived the
<br /> , ,, , ,,, , , approval of theA Board Q; Appeals.
<br /> Name
<br /> If any conditions are,.w.rit 11 ow
<br /> !
<br /> ,,, , ,, , , , ,, , ,, , ,,, ,, , ,, , ,, ,, ,,, ,,,, , you are requested to -see tha 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 /> Yes or No
<br /> . . . . .. . . . . . . . . . . . . . . . . . . . .. . .. . . . . . .
<br /> Date .. . . . . . . . ... . .. .19. .. .
<br /> . . .. . . . .. . .. . . . . . . . . . . ..... .. . . . . . .
<br /> . . .. .. . .. . . .. . . . . . . .. . . . . . .... .. . . .
<br /> If permit 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 />
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