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<br /> EXHIBIT C <br /> ENVIRONMENTAL REVIEW FOR <br /> NORTH PENINSULA NEIGHBORHOOD SERVICES CENTER <br /> HOUSING REVIT ALIZA TION PROGRAM <br /> Date: <br />A. This is to request an Environmental review for a proposed project at the following address: <br /> . <br />B. This address is a ( )Single family home ( ) An apartment _Age of bldg. if known <br />C. The improvements to be made to this home/apartment are: ( ) interior* ( ) exterior* <br /> NOTE: If both interior and exterior improvements are proposed, check both boxes and identify <br /> which irr¡)roverœnts are exterior. For exterior improvements to be made to a building which is at least <br /> 50 years old, please provide a site plan showing the location and extent of the improvements to the <br /> budding, a work write-up order and/or plans and specifications of the improvements. <br /> *Interior means the inside of a home, or an apartment. Exterior means the outside of a home or a <br /> multifanùly building. Improvements to be made outside an apartment, but inside a multifamily family <br /> building (such as in hallways, lobbies or stairways) are also considered "exterior" for this purpose. <br />D. The improvements will consist of the installation or construction of: <br /> () Doors and window repair/replacement including screen doors/windows <br /> ( ) Plumbing fixtures repaired/replaced <br /> ( ) Porch steps reinforced/repaired <br /> ( ) Aoor/waU repair <br /> ( ) Installation of smoke and carbon monoxide detectors <br /> ( )Energy education and assessment <br /> ( )Attic insulation <br /> ( )Ooor Weatherstripping <br /> ( ) W aler heater wrap <br /> ( ) Fumance filters <br /> ( ) Energy efficient showerhead <br /> ( )Electrical outlet gaskets caulking <br /> Other (Please identify): <br />From: North Peninsula Neighborhood Services Center <br /> Contact person and telephone: <br />