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EXHIBIT C <br /> <br /> ENVIRONMENTAL REVIEW FOR <br /> NORTH PENINSULA NEIGHBORHOOD SERVICES CENTER <br /> HOUSING REVITALIZATION AND ENERGY PROGRAM <br /> <br /> Date: <br /> <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 /> <br />C. The improvements to be made to this home/apartment are: ( ) interior* ( ) exterior <br /> <br />NOTE: If both interior and exterior improvements are proposed, check both boxes and identify which <br />i=rovements are exterior. For exterior improvements to be made to a building which is at least 50 years <br />old, please provide a site plan showing the location and extent of the improvements to the building, a <br />work write-up order and/or plans and specifications of the improvements. <br /> <br />*Interior means the inside of a home, or an apartment. Exterior means the outside of a home or a <br />multifarnily 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 /> <br />D. The improvements will consist of the installation or construction of: <br /> <br />( Doors and window repair/replacement including screen doors/windows <br />( Plumbing fixtures repaired/keplaced <br />( Porch steps reinfomed/repaired <br />( Floor/wall repair <br />( Installation of smoke and carbon monoxide detectors <br /> <br />( Energy education and assessment <br />( Attic insulation <br />( Door Weatherstripping <br />( Water heater wrap <br />( Furnace filters <br />( Energy efficient showerhead <br />( Electrical outlet caskets caulking <br /> <br />Other (Please identify):, <br /> <br />From: North Peninsula Neighborhood Services Center <br />Contact person and telephone: <br /> <br /> <br />