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t SPECIAL PERMIT Date . ... . . .. . .. .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 /> . . . . .. . .. . . . . . .. . . . . . . . . . . . .. . . . . . . <br /> Date . . . .. .. . . . . . .. ..19. . .. <br /> . . . . . . . . . . . . . . . . . . .. . . . . . . .. . . .. . . . <br /> - l <br /> ... .. . . . . . . . . . . . . . . . .. . .. . . .. . . . . . . . <br /> t <br /> Ifpermit was granted what other . .. ... • • • • • •.. . . . . . . . . . . ... . . . . • • • • • <br /> permits were issued by the Building <br /> f Department? <br /> Y 13 + To Build? . . . .. . .. . . . . .. . . . .. . .. . . . ... . . . . . .. .. . .. .. .. .. . .. . . . . . . . . . <br /> (Yes or.No). . .(date).. .. . . . . . .. . .. . .. .. . . . . ..: . .. . . . .... . . : <br /> x <br /> Use & Occupancy? Board of Appeals <br /> . (Yes or No) (date) <br />