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IF <br /> SPECIAL PERMIT Date . . .. . .. .. . . .19.. . . <br /> File . .. .. .. .. To Building Inspector <br /> issue <br /> Application for Special Permit aouSpecialarerebPermittforlzethistapplica- <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 /> fit . . ... . .... . .. . .. . .. .. . .. .. . . . . . .. . . <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 /> r ' <br /> Use & Occupancy? . .. . . . . . . . . ... . .. .. <br /> (Yes or No) (date) Board of Appeals <br />