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W <br />SPECIAL PERMIT <br />File................................ <br />APPLICATION for SPECIAL PERMIT <br />....................................................................................... <br />Name <br />............................................................................... <br />Location <br />...................................................................................... <br />......................... :............................................................ <br />........................................................................................ <br />Permit granted (....................j <br />Yes or No <br />Date................................ 19....' <br />If permit was granted what other permits <br />were Issued by the Building Dept? <br />ToBuild? ..:........................... .............................. <br />(Yes or No) (date) <br />Use & occupancy? .................................................. <br />(Yes or No) (date) <br />Date................................ 19...... <br />To Building Inspector: <br />You are hereby authorized to issue a <br />"Special Permit" for this application for <br />signature of the Board of Appeals and are <br />hereby advised that this application has <br />received the approval of the Board of <br />Appeals. <br />If any conditions are written below, you <br />are requested to see that they are complied <br />with, and included In permit. <br />Conditions (if any)...................................... <br />...................................................................................1.1. <br />..................................................................................... . <br />..........................................................................I.......... <br />...................................................................................... <br />