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SPECIAL PERMIT Date ................................ <br /> Me ...................... <br /> ' To Building Inspector: <br /> FLS1 <br /> You are here pyzauthorized Lssus a <br /> APPLICATION for SPECIAL PERMIT ;; "Special Permit" I for)tthis appl ion for <br /> signature of the Boardfpf Appea dare <br /> hereby advised thatthis application has <br /> received the approv a1 woof the ftoard of <br /> Appeals. r <br /> .... ...... .... . . .............Name... ...... ! <br /> If any conditions a{xe written ow, you <br /> are requested to see_tha they are complied <br /> with, and included in permit. <br /> Loeation <br /> Conditions (if any) ..................................... <br /> ............................. r <br /> _.......................................................... ... <br /> ............ <br /> ........... . <br /> ..................................................................................... . <br /> ........................................................................................ <br /> Perot granted (:...................) <br /> Yes or NO <br /> .................................................................................... <br /> Date ................................ 19...... ..................................................................................... <br /> If permit was granted what other permits R"... <br /> were Issued by the Building Dept?, ^> . <br /> a�Y <br /> ToBuild? .............................. ............................. <br /> (Yes or No) (date) .................................................. <br /> *- Use & occupancy? ............................. .................... <br /> .................................................................. . <br /> (Yes or No) (date) Board of Appeals <br />