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SPECIAL PERMIT Date . . ..I . . .. . . . .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 /> Conditions (if any) .. .. .. . ... . . . . . <br /> . . ....... . .. ... . . .. .. . . . . ... .. . .. . . <br /> t7 . . . . . ... . .. . . . .. . . . . .. .. . <br /> h` <br /> 'tJ . <br /> Permit granted ( . . .. ) <br /> ` Yes or No <br /> . . . . . . . .. . .. . . .. . . . . .. . .. . . . . . . . . . . <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 /> .s <br /> Use & Occupancy? . . . . . . . . . . . . .. . . . . . . . . .. .. . . . . . .. . . <br /> - (Yes or No) (date) Board of Appeals <br />