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[null,"株式会社ＬＩＸＩＬ 行き",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"依頼日：　            年       月        日"]
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[]
[]
[null,"こどもみらい住宅支援事業 窓性能証明書発行依頼書【二重窓リフォーム用ガラス】"]
[]
[]
[]
[null,"証明書発行区分",null,null,null,null,null,null,null,null,null,null,null,null,"省エネ"]
[null,"下記物件の窓リフォーム改修の『性能証明書』の発行依頼をお願いします。"]
[]
[]
[null,"依  頼  区  分",null,null,null,null,null,null,null,"ガラス交換       "]
[null,"依 頼 会 社 名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"依  頼  者  名"]
[null,"組 立 事 業 者 名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担  当  者  名"]
[null,"元 請 業 者 名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"担  当  者  名"]
[null,"施 工 現 場 名",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"地  域  区  分",null,null,null,null,null,null,null,"1～3",null,null,4,null,null,"5～7",null,null,8]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※8地域対応は汎用ガラス用性能証明書発行依頼書で申請してください。"]
[null,"施 工 現 場 住 所",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"※本書類に記載された個人情報は性能証明書発行および送付する場合のときのために使用します。"]
[]
[]
[null,"符号",null,"納品日",null,null,null,"製品名",null,null,null,null,null,null,null,null,null,null,null,null,"外窓・内窓",null,null,null,null,"建具の仕様",null,null,null,null,null,null,null,null,null,null,"ガラスサイズ（ＷＨ）",null,null,null,null,null,null,null,null,null,"備考"]
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[null,1,null," 月    日",null,null,null,"Low-E複層ガラス\n\n一般複層ガラス",null,null,null,null,null,null,null,null,null,null,null,null,"外窓",null,null,null,null,"材料は問わない\n\n内窓、外窓の少なくともいずれかが、樹脂または木または金属とその他材料の複合",null,null,null,null,null,null,null,null,null,null,"W＝"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"内窓",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"H＝"]
[null,2,null," 月    日",null,null,null,"Low-E複層ガラス\n\n一般複層ガラス",null,null,null,null,null,null,null,null,null,null,null,null,"外窓",null,null,null,null,"材料は問わない\n\n内窓、外窓の少なくともいずれかが、樹脂または木または金属とその他材料の複合",null,null,null,null,null,null,null,null,null,null,"W＝"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"内窓",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"H＝"]
[null,3,null," 月    日",null,null,null,"Low-E複層ガラス\n\n一般複層ガラス",null,null,null,null,null,null,null,null,null,null,null,null,"外窓",null,null,null,null,"材料は問わない\n\n内窓、外窓の少なくともいずれかが、樹脂または木または金属とその他材料の複合",null,null,null,null,null,null,null,null,null,null,"W＝"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"内窓",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"H＝"]
[null,4,null," 月    日",null,null,null,"Low-E複層ガラス\n\n一般複層ガラス",null,null,null,null,null,null,null,null,null,null,null,null,"外窓",null,null,null,null,"材料は問わない\n\n内窓、外窓の少なくともいずれかが、樹脂または木または金属とその他材料の複合",null,null,null,null,null,null,null,null,null,null,"W＝"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"内窓",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"H＝"]
[null,"◆ガラス性能証明書発行依頼に必要な添付書類"]
[null,null,"□ ㈱ＬＩＸＩＬが発行した納品書（コピー可）"]