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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 /> Permit granted ( . .. . . . .. . . <br /> ) <br /> Yes or No <br /> Date .. .. . . . . . . . .. .. .19.. . . <br /> . . .. .. . .. . .. . . .. . . . . .. .. .. .. . . . . . . . <br /> . . . . . . . . . . . .. . . .. . . . .. .. .. . . . . . . . . . <br /> Ifpermit was granted what other • • •• •• • • • • ••. . . .. . . ... . .. . . . . . .•• • • • <br /> permits were issued by the Building <br /> Department? <br /> . . ... . .. . . .. .. . . . .. .. .. . . . . .. .. . . . . <br /> op To Build? . . . . . .. . <br /> fr ,. ^•, (Yes or No) (date) . . . .. . .. .. . .. . .. . .. .. .. . . . . .F.... . : <br /> Y <br /> Use & Occupancy? Board... Appeals <br /> t/r � (Yes or No) (date) <br /> . a <br /> C* <br /> u <br />