This is a request to the holder of a copyright asking permission to use the copyrighted material in a book or article. There is an attached addendum for the copyright holder to sign granting permission. The request can be granted for only a fixed period of time if the copyright holder does not want to grant the request to be used indefinitely.
To request permission, you typically need to reach out to the copyright owner directly. It’s like asking for the green light before using someone else's work.