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SPECIAL PERMIT Date . . .. . . . .. . .. .19. . . . <br /> File .. . .. .. . . To Building Inspector <br /> Application for Special Permit You are hereby authoriA to is ue <br /> a "Special Permit/ f 1 this %ppli�a- <br /> tion for signature e Wo, rd o` <br /> Appeals and are helby advt tf at <br /> this application ha'� r1ecei�ed the <br /> „• , , ,, , ,,,, „ approval of the Board f Appeals. <br /> Name X <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 /> Yesor No .. . . . . . ... . . . . . . . .. .. . .. . ... .. . . . . <br /> Date . . . . .. . . . . . .. .. .19. . .. <br /> . . . . . . . .. . .. . . .. . . .. . . .... . ... .. . . . <br /> Ifpermit was granted what other • • •• •• • • • . •• • • •• • • ••• • •••• • • •• • • • • . <br /> permits were issued by the Building <br /> Department? <br /> . . ... . .. . . .. . . . . . . .. . . .. . .. . . . . .. .. <br /> ToBuild? . . . .. . ... . ... .. .. .. . . . . <br /> (Yes or No) (date) . . .. . . . .. . . .. . . .. . . ... . .. . ... ... .. . <br /> Use & occupancy? .. .. .. . .. . . . . . .. . . . . .. . . . . . . . . .. . . .. . . . . . . Appeals <br /> (Yes or No (date) Board of <br /> R <br />