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[{"$nulls":27},"別記様式１号"]
[]
["現金取得者向け新築対象住宅証明書審査申請書"]
["（第一面）"]
[]
[{"$nulls":23},"年",null,"月",null,"日"]
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["一般財団法人　福岡県建築住宅センター　殿"]
[]
[]
[{"$nulls":14},"証明申請者の住所又は"]
[{"$nulls":14},"主たる事務所の所在地"]
[{"$nulls":14},"証明申請者の氏名又は名称"]
[]
[{"$nulls":14},"代理者の住所又は"]
[{"$nulls":14},"主たる事務所の所在地"]
[{"$nulls":14},"代理者の氏名又は名称"]
[]
[]
[null,null,null,"現金取得者向け新築対象住宅証明書発行のための適合審査を申請します。"]
[null,null,null,"この申請書及び提出図書に記載の事項は、事実に相違ありません。"]
[]
[]
["記"]
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[]
["【住宅の所在地（地名地番）】",{"$nulls":7},"福岡県"]
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["【住宅又は建築物の名称】"]
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["【住宅の建て方】",{"$nulls":7},"■","一戸建ての住宅",{"$nulls":6},"□","共同住宅等"]
[]
["【適用する住宅性能】"]
[null,"住宅の新築\n又は\n新築住宅の取得"]
[{"$nulls":6},"□","断熱等性能等級４"]
[{"$nulls":6},"□","一次エネルギー消費量等級4以上"]
[{"$nulls":6},"□","劣化対策等級３で、かつ、維持管理対策等級２以上"]
[{"$nulls":8},"（共同住宅等については一定の更新対策が必要）"]
[{"$nulls":6},"□","耐震等級（構造躯体の倒壊等防止）の等級２以上"]
[{"$nulls":8},"（耐震等級３に係る適合審査を受けようとする場合",{"$nulls":11},"□","耐震等級３",null,null,"）"]
[{"$nulls":6},"□","免震建築物"]
[{"$nulls":6},"□","高齢者等配慮対策等級３以上の住宅"]
[]
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["【評価書等※1の有無】",{"$nulls":5},"□","有",null,"■","無"]
[null,null,"□","設計住宅性能評価書"]
[null,null,"□","建設住宅性能評価書　　"]
[null,null,"□","長期優良住宅建築等計画に係る技術的審査適合証　"]
[null,null,"□","低炭素建築物新築等計画に係る技術的審査適合証"]
[]
["【証明基準を満たす認定書等の有無】",{"$nulls":9},"□","有",null,"■","無"]
[null,null,"□","住宅型式性能認定書",{"$nulls":6},"□","型式住宅部分等製造者認証書",{"$nulls":8},"□","その他"]
[]
[null,"※受付欄",{"$nulls":6},"※料金欄"]
[null,null,null,"年",null,"月",null,"日"]
[null,"第",{"$nulls":5},"号"]
[null,"依頼受理者印"]
[null,"※1　評価書等については当センターで発行されたものに限ります"]
[]
["（第二面）"]
[]
[]
[]
["【代理者】"]
[null,null,null,"フリガナ","："]
[]
[null,null,null,"氏名又は名称","："]
[]
[null,null,null,"〒","："]
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[null,null,null,"住所","："]
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[null,null,null,"電話番号","："]
["【設計者】"]
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[null,null,null,"氏名","："]
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[null,null,null,"建築士事務所名","："]
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[null,null,null,"〒","："]
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[null,null,null,"所在地","："]
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[null,null,null,"電話番号","："]

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["委　任　状"]
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[null,null,"　私は、",{"$nulls":20},"を代理人と定め、"]
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[null,null,"下記の建築物に関する現金取得者向け新築対象住宅証明書審査申請に関する手続き、申請図書の作成、"]
[null,null,"訂正及び登録住宅性能評価機関から交付される文書の受領、その他これに関連する必要な一切の権限を"]
[null,null,"委任します。"]
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["記"]
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[]
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[]
[]
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["【住宅又は建築物の名称】"]
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[{"$nulls":26},"印"]
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