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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 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 /> ,_, , , 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 /> Permit granted ( . . . . . .. . . . <br /> ) <br /> Yes or No <br /> Date .. .. .. . . . . .. . .. .19. .. . <br /> . . .. . . .. .. . ... . . . . . . . . .. .. . . . . . . . . . <br /> If permit was granted what other . . .. . . . . .. . . . . . .. . . . . . . . . . . . . . .. . . . <br /> permits were issued by the Building <br /> Department? <br /> . . .. . . . .. . .. . . .. . .. .. . . . . .. . .. . . . . . <br /> To Build? .. . .. . . . . . . .. .. .. .. . .. . <br /> ® (Yes or No) (date) . . . .. . . . . . . .. . . .. . .. . . . . . . . <br /> ca <br /> Use & Occupancy? .. . .. . . . . . . . .. . .. . . . ...B. . <br /> vR (Yes or No) (date) oard of Appeals <br /> 4 <br />