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� ,11-10—'17 12:40 FROM— T-124 P4002/0007 F-514 <br /> � '�i:'�� 4, ri- ., ;�, /�v+��7T 4 �.. / .. �.. � rr,x,.. ��. .,i';,:. <br /> rt `tYLc �.:���'�, :, .7`:;;rk;•' :�'t 'V..k+..�5,�'t . ...��.'� ' ; .�.,�:. .,1iYv3..... ��'�..' ... �t4%5y .���l�.".��` 2�f <br /> ..w..�.�•F.t`Z'....r...t.. 44t:.. �•. <br /> Note:All Geothermal Systems will now require a Site PIan&Revie�v by pur Building Official. <br /> XS'�'�XXS CEOTX��RMAY,? ❑'Yes �]N'o <br /> �Y�ATING S'YST�1�15 <br /> Make: <br /> Model: <br /> �'uel: <br /> �lue Size: <br /> Input BTUs: <br /> Output BTUs: <br /> CPM: <br /> COO�TNC S'YSTE1vIS <br /> Quantity: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> �yR�pT.AC�S �7����0"6���7� <br /> � Gas Factory PirepIace Brand Name: � <br /> ❑ \Vood Buming Fireplace <br /> ❑ Wooci Sto'vt Model No.� <br /> ❑ VV'ood Stove with Flue/Masonry <br /> V ENT[LATION <br /> ❑ No. Kitchcn ExhAust duct recirculating cfm <br /> ❑ No. Bath ExhAust(must havt duct ot�tsidc) cfm <br /> ❑ No_ Othar Fans� Locations cfm <br /> FUEI.S'TOItAG� (Mirst be appruved by FFre A�nrsl�all if proposirig to abarrdo��tnnk i�r pince.) <br /> ❑ Installacion ❑ Removal <br /> Fuol Oil: gallons ❑ Undorground ❑Inside ❑Outside <br /> LP G�s: galtons <br /> Other: <br /> GAS LCNE ONLY <br /> ❑ Outdoor Grill ❑ Other/List�Vhat&l�Vhere: <br /> 2 <br />