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T SPECIAL PERMIT Date . . .. . . .. . . . .19.. . . <br /> File ... ., .. . . To Building Inspector <br /> w <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 /> .. .. .. . .. .. . . . .. .. . . . ... .. . . .. . . .. . . . . . .. .. ... .. .. .. . .. ... ... . . . . . . .. . . <br /> Permit granted ( . . .. .. ) <br /> Yes or No <br /> Date .. .. . .. . . . . ...: .19. .. . <br /> Ifpermit was granted what other . .. .. . • •• • ••. . . .. . . ... . . . .. . . .. • • • • • <br /> permits were issued by the Building <br /> Department? <br /> . .. . . .. . . .. .. . . . .. . . . . . .. . .. . . . . . . <br /> To Build? . .... . .. . . . . .. . . . .. . .. . <br /> (Yes or No) (date) .. . .. . . .. . I . . . .. . . . .. . . . . . . . . . . .. . . <br /> Use & Occupancy? .. . .. <br /> (Yes or No) (date) Board of Appeals <br /> cp <br /> r; <br />