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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' r this applica- <br /> tion for signatur f the Board of <br /> Appeals and are h eby advised that. <br /> this application received the <br /> ,,, , , approval of the. Board of Appeals. <br /> Name • <br /> If any condition re written below <br /> , ,, ,, you are requeste o see that they <br /> Location are complied with, and included in <br /> permit. <br /> .... . ..... . . . .. . .. .. . . .. .. .. . ... .. .. <br /> ... . . . .. .. . . .... .. . . .. . ..... .. . .. .. . <br /> Conditions (if any) .. .. ... . . . . . .. . <br /> .. .. .. . . ... . . .. . . . . . . . .. . . ... .. . .. .. <br /> .. ..... ...... . . ... . ... . .. . ... . .. . . . <br /> . . .... ... . .. . . .. . . . . . . .. ...... .. .. . <br /> Permit granted ( . .. . ..... . <br /> ) <br /> Yes or No <br /> Date .. .. . .. . . . . . .. . .19. .. . . . .. . . .. . . .. . . .. . . .. . ..... . ... .. . . . <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 /> : <br /> Use & Occupancy? .. . .. . . . . . . .. . . .. .. . . . .. . . . ... .. . . . , <br /> (Yes or No)•(date) Board of Appeals <br />