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["第四十一号様式（第八条関係）（Ａ４）"]
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["建築基準法第15条第１項の規定による"]
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["建築物除却届"]
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["（第一面）"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,"月",null,null,"日"]
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[null,null,null,null,null,null,null,null,null,null,"知事　様"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,"除却工事施工者"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"郵便番号"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"住所"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"氏名"]
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[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"電話番号"]
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[]
[]
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[null,"※受付経由機関記載欄"]
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["（第二面）"]
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["【１．除却予定期日】",null,null,null,null,null,null,null,null,null,null,null,null,null,"年",null,null,null,null,"月",null,null,null,null,"日"]
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["【２．除却場所】"]
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[]
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["【３．主要用途】",null,null,null,null,null,null,"(1)居住専用建築物",null,null,null,null,null,null,null,null,"（",null,null,null,null,"）"]
[]
[]
[null,null,null,null,null,null,null,"(2)居住産業併用建築物",null,null,null,null,null,null,null,null,"（",null,null,null,null,"）"]
[]
[]
[null,null,null,null,null,null,null,"(3)産業専用建築物",null,null,null,null,null,null,null,null,"（",null,null,null,null,"）"]
[]
[]
[]
["【４．除却原因】",null,null,null,null,null,null,null,"(1)老朽して危険があるため",null,null,null,null,null,null,null,null,null,null,null,"(2)その他",null,null,null,null,null,null,null,null,null,null,false]
[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,false]
[]
[]
["【５．構造】",null,null,null,null,null,null,null,"(1)木造",null,null,null,null,null,null,null,null,null,null,null,"(2)その他",null,null,null,null,null,null,null,null,null,null,false]
[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,false]
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["【６．建築物の数】"]
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[]
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["【７．住宅の戸数】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"戸"]
[]
[]
[]
["【８．建築物の床面積の合計】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"㎡"]
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[]
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["【９．建築物の評価額】",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"千円"]
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[null,"（注意）\n１．第一面関係\n  　※印のある欄は記入しないでください。\n２．第二面関係\n  ①　各欄は、除却しようとする建築物について記入してください。\n  ②　３欄において「(1)居住専用建築物」に該当する場合は、次の表の記号の中から該\n　　当するものを選んで括弧内に記入してください。"]
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[]
[]
[]
[]
[]
[]
[]
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[null,"主要用途の区分",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記号"]
[null,"居住専用住宅（附属建築物を除く。）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"01"]
[null,"居住専用住宅附属建築物（物置、車庫等）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"02"]
[null,"寮、寄宿舎、合宿所（附属建築物を除く。）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"03"]
[null,"寮、寄宿舎、合宿所附属建築物（物置、車庫等）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"04"]
[null,"他に分類されない居住専用建築物",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"05"]
[]
[null,"　③　３欄において「(2)居住産業併用建築物」又は「(3)産業専用建築物」に該当する\n　　場合は、産業の用に供する部分について、次の表の記号の中から該当するものを選\n　　んで括弧内に記入してください。また、一敷地内に除却しようとする建築物以外に\n　　既存の建築物があるときは、記入に際しては、その部分と除却しようとする部分と\n　　を総合して判断してください。"]
[]
[]
[]
[]
[]
[]
[]
[]
[null,"主要用途の区分",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"記号"]
[null,"農林水産業",null,null,null,null,null,null,"農業、林業、漁業、水産養殖業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"11"]
[null,"鉱業、採石業、砂利採取業、建設業",null,null,null,null,null,null,"鉱業、採石業、砂利採取業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"12"]
[null,null,null,null,null,null,null,null,"建設業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"13"]
[null,"製造業",null,null,null,null,null,null,"食料品製造業、飲料・たばこ・飼料製造業、繊維工業、木材・木製品製造業、家具・装備品製造業、パルプ・紙・紙加工品製造業、印刷・同関連業、プラスチック製品製造業（記号15から記号18までに該当するものを除く。）、窯業・土石製品製造業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"14"]
[]
[]
[null,null,null,null,null,null,null,null,"化学工業、石油製品・石炭製品製造業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"15"]
[null,null,null,null,null,null,null,null,"鉄鋼業、非鉄金属製造業、金属製品製造業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"16"]
[null,null,null,null,null,null,null,null,"はん用機械器具製造業、生産用機械器具製造業、業務用機械器具製造業、電子部品・デバイス・電子回路製造業、電気機械器具製造業、情報通信機械器具製造業、輸送用機械器具製造業、",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"17"]
[]
[null,null,null,null,null,null,null,null,"ゴム製品製造業、なめし革・同製品・毛皮製造業、その他の製造業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"18"]
[null,"電気・ガス・熱供給・水道業",null,null,null,null,null,null,"電気業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"19"]
[null,null,null,null,null,null,null,null,"ガス業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"20"]
[null,null,null,null,null,null,null,null,"熱供給業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"21"]
[null,null,null,null,null,null,null,null,"水道業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"22"]
[null,"情報通信業",null,null,null,null,null,null,"通信業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"23"]
[null,null,null,null,null,null,null,null,"放送業、情報サービス業、インターネット附随サービス業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"24"]
[null,null,null,null,null,null,null,null,"映像・音声・文字情報制作業（新聞業及び出版業を除く。）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"25"]
[null,null,null,null,null,null,null,null,"映像・音声・文字情報制作業（新聞業及び出版業に限る。）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"26"]
[null,"運輸業",null,null,null,null,null,null,"鉄道業、道路旅客運送業、道路貨物運送業、水運業、航空運輸業、倉庫業、運輸に附帯するサービス業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"27"]
[]
[null,"卸売業、小売業",null,null,null,null,null,null,"卸売業、小売業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"28"]
[null,"金融業、保険業",null,null,null,null,null,null,"金融業、保険業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"29"]
[null,"不動産業",null,null,null,null,null,null,"不動産取引業、不動産賃貸業・管理業（駐車場業を除く。）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"30"]
[null,null,null,null,null,null,null,null,"不動産賃貸業・管理業（駐車場業に限る。）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"31"]
[null,"宿泊業、飲食サービス業",null,null,null,null,null,null,"宿泊業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"32"]
[null,null,null,null,null,null,null,null,"飲食店、持ち帰り・配達飲食サービス業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"33"]
[null,"教育、学習支援業",null,null,null,null,null,null,"学校教育",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"34"]
[null,null,null,null,null,null,null,null,"その他の教育、学習支援業（社会教育に限る。）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"35"]
[null,null,null,null,null,null,null,null,"その他の教育、学習支援業（学習塾及び教養・技能教授業に限る。）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"36"]
[null,null,null,null,null,null,null,null,"その他の教育及び学習支援業（記号35及び記号36に該当するものを除く。）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"37"]
[null,"医療、福祉",null,null,null,null,null,null,"医療業、保健衛生",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"38"]
[null,null,null,null,null,null,null,null,"社会保険・社会福祉・介護事業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"39"]
[null,"その他のサービス業",null,null,null,null,null,null,"郵便業（信書便事業を含む。）、郵便局",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"40"]
[null,null,null,null,null,null,null,null,"学術・開発研究機関、政治・経済・文化団体",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"41"]
[null,null,null,null,null,null,null,null,"その他の生活関連サービス業（旅行業に限る。）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"42"]
[null,null,null,null,null,null,null,null,"娯楽業",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"43"]
[null,null,null,null,null,null,null,null,"宗教",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"44"]
[null,null,null,null,null,null,null,null,"物品賃貸業、専門サービス業、広告業、技術サービス業、洗濯・理容・美容・浴場業、その他の生活関連サービス業（旅行業を除く。）、協同組合、サービス業（他に分類されないもの）(記号41及び記号44に該当するものを除く。）",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"45"]
[]
[]
[null,"国家公務、地方公務",null,null,null,null,null,null,"国家公務、地方公務",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"46"]
[null,"他に分類されないもの",null,null,null,null,null,null,"他に分類されないもの",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"99"]
[]
[null,"　 ④　４欄及び５欄は、該当するチェックボックスに「レ」マークを入れてください。"]