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SPECIAL i �-iMT Date . . . .. . .. .19. . . . <br /> File . . . .. .. . . To Building Insp <br /> Application for Special Permit You are her uD <br /> a "Special it' li <br /> tion fors urd <br /> Appeals an ht <br /> this applic n t <br /> . .. . . . . . .. .. . .. . .. .. ... . . . . . .. .. . .. . approval of <br /> Name <br /> If any conditilow <br /> . . .. . . . . .. . . .. . . .. .. . . . . .. .. .. . . . .. . you are requestethey <br /> Location are complied with, and included in <br /> permit. <br /> . ... .. .. .. .. . .. . Conditions (if any) . .... . .. .. . . <br /> Permit granted <br /> Yes or No <br /> . . .. .. . .. . . .. . . .. . ... . .. . ... . . .. . . . <br /> Date .. ... ... . ... ... .19... . <br /> . . ... . .. .. .... .. . . .. ....... .. . . .. . . <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 /> Use & Occupancy? . . . . . . .. . . . . . . " "" " " " " Board of Appeals <br /> (Yes or No) (date) <br />