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SPECIAL PERMIT 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 /> .. . . .. .. .. .. . .. . . . . . .. .. . . .. . . . . . . . . <br /> Conditions (if any) .. .. .. . . . . . . . . . <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 /> . . ... . .. . . .. . . . .. . . . ... . . . . .. . . . . . . <br /> To Build? . . ... . .. . . . . .. . . .. . . .. . <br /> (Yes or No) (date) <br /> Use & Occupancy? .. . .. . . . . . . . .. . .. .. . . . . .. .. . .. . .. . . . .. . . <br /> ,may <br /> Board of Appeals <br /> - (Yes or No) (date) <br /> ' QT <br />