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. �. <br /> � <br /> HEATING SYSTEMS <br /> Quantity: � / <br /> Make: _��� � ' � Z'-� <br /> IVIodeL• 3J'SLA y�SIZ/�l.� <br /> Fuel: C�/y� <br /> Flue Size: Z" <br /> I�ut BTLTs: (p�;d?r0 �� <br /> ou�ut sTus: .5' SSD� <br /> � <br /> CFM: ��� � <br /> COOLING SYSTEMS <br /> Quantity: ! <br /> Make: �/`y�� <br /> Model: /�p�AAl/9Q� <br /> Tons: �,� <br /> H.Power <br /> FIREPLACES <br /> ❑ Gas Factory Fireplace <br /> ❑ Wood Burning Fireplace <br /> ❑ Wood Stove <br /> ❑ Wood Stove With Flue <br /> Brand Name: Model No.: <br /> VENTILATION <br /> � No. � Kitchen Exhaust /� duct recirculating Juu cfin <br /> � No. _� Bath Exhaust(must have duct outside) �/Q cfin <br /> ❑ No. Other Fans: Locations cfm <br /> FUEL STORAGE(MUST BE APPROVED BY FIltE MARSHALL) <br /> ❑ Installation ❑ Removal <br /> Fuel Oil: gallons ❑ Underground ❑Inside ❑ Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill � Other/List What&Where: '��C�p ,Q�lLref,T�c.�'�ta,CD, �� <br /> 2 <br />