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SPtr tit:' reRt•11"f r, <br /> AtM 19, <br /> -ile .. . . . . . . . ?o Building Inspector <br /> Appiieation For Special ✓ennit You are hereby authorized to issue <br /> a "Special Permit' for this applica•- <br /> ��� � � tion for signa._tur•e of the Board ri <br /> Appeals and are hereby advised than <br /> this application ha3 received the <br /> . . . . . . . . . . . . . . .. . .. . I . . . . . . . . approval of the Board of Appeals. <br /> Name <br /> If any conditions are written teloiN <br /> . . . . . .. . .. . . . . . . .. . . . . . . . .. . . ... . . . .. you are requested to seg that they <br /> Location are complied with, and included in <br /> perrai.t . <br /> . <br /> Conditions (if any) . . . . . . . . .. . . . . . <br /> . . . . . . . . . . . . . . . . . . . . .. . .. . . .. . . . . . . <br /> . . . ... . . ...... . . . . .. . . . . . . . .. . . . . . . . <br /> .. . . .. . .. . . . . . . . . . . . . . . . .. .. . . . .. . . . <br /> . . .. . . . . . . .. . . . . . . ... ..... . .. . . . . . . <br /> Permit granted <br /> Yes or No <br /> . . .. . . :. .. . . . . . . . . . .. . . .. ...... . . . . <br /> Date .. . . . .. . . . .. . .. .19. .. . <br /> . . .. . . . . . .... . . . . .. . .. . . . .. . . . <br /> J. <br /> If permit was granted what other . . .. .. . .. . .. . . . . . . . . . . ••• • • • <br /> -, permits were issued by the Building <br /> Department?. <br /> . . .. .. . . ... .. . ..... .. . ... . ... ... . . . <br /> To Build? <br /> A ._ (Yes or No) (date) . . ... . .. . . . ... .. . . .. . .. ... . .. .. . . . <br /> Use & Occupancy? .. . .. . . . .. ... . . . . . . . . .. . . . . . . . . . . . . .Board of Appeals <br /> (Yes or No) (date) <br /> � J <br /> } <br /> - - - <br />