Laserfiche WebLink
EXHIBIT C <br /> <br /> ENVIRONMENTAL REVIEW FOR <br /> NORTH PENINSULA NEIGHBORHOOD SERVICES CENTER <br /> HOUSING REVITALIZATION 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 am: ( ) interior* ( ) exterior <br /> <br /> NOTE: If both interior and exterior improvements am proposed, check both boxes and identify <br /> which improvements are exterior. For exterior improvements to be made to a building which is at <br /> least 50 years old, please provide a site plan showing the location and extent of the improvements to <br /> the building, a 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 /> multifamily building. Improvements to be made outside an apartment, but inside a multifamily <br /> family building (such as in hallways, lobbies or stairways) are also considered "exterior" for this <br /> 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/replaced <br /> ( ) Porch steps reinforced/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 gaskets caulking <br /> <br /> Other (Please identify):_ <br /> <br /> From: North Peninsula Neighborhood Services Center <br /> Contact person and telephone: <br /> <br /> <br />