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SPECIAL PERMIT Date . . . . . .. . . . . .19. . . . <br /> File . .. .. . . . . <br /> To Building Inspector <br /> ector <br /> 1 You are hereby authorized to issue <br /> Application for Special Permit a "Special Permit1 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 /> �'�e5?� FSM `�t , � •51' , , approval of the Board of Appeals. <br /> Name f <br /> If any conditions are written below, <br /> ` t`,` ,, , you are requested to see that they <br /> Locatidn are complied with, and included in <br /> permit. <br /> .... .. .. .. . . ... . .. . . ... . . .. . . . . . . .. . <br /> Conditions (if any) .. . .. . .. . . <br /> . ... . .. .... . .. .. . .. . . . .. .. .. .. . . .. .. <br /> . . <br /> ... . . . .. .. . . . . . . . .. . . . . . . . . . . . . .. . . . <br /> . . .... .. . .... . . ... . .. . .. .. . . . . .. . . . <br /> Permit granted ( . .. .. .. . . . <br /> ) <br /> Yes or No <br /> Date .. .. .. . . . . .. . . . .19. . . . <br /> . . .. . . . . . . . . . . .. . . .. . . .. .. . . . . . . . . . <br /> Ifpermit was granted what other . .. . . . .. . . . . . . .. . . ... . .. .. ... .. . . .. . <br /> permits were issued by the Building <br /> Department? <br /> �. To Build? . . .. .. . . . . . . . . . . . .. . . . .. . . . . . . . . . . . <br /> _l F (Yes or No) (date) <br /> dd <br /> t . <br /> Use & Occupancy? .. . .. " " " " " "" " ' ' <br /> - - (Yes or No) (date) Board of Appeals <br />