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,�,`_ � <br /> _ ` <br /> Note: All Geothermal Systems will now require a Site Plan&Review by our Building Official. <br /> IS TffiS GEOTHERMAL? ❑ Yes '�,No <br /> HEATING SYSTEMS <br /> Quantity: l <br /> Make: �e�t � <br /> Model: �)/�'�(/(�7'���a� <br /> Fuel: ,(�Lc,,� �j�[g <br /> Flue Size: �j�� pU� <br /> Input BTUs: rJ� <br /> Output BTUs: �_�Z� <br /> CFM: <br /> COOLING SYSTEMS <br /> Quanrity: <br /> Make: r' � <br /> Model: ��j G�/SE-�3� <br /> Tons: � <br /> H.Power � <br /> FIREPLACES <br /> � Gas Factory Fireplace Brand Name: �T�LTI(�9� ����+� <br /> Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove With Flue <br /> VENTILATION <br /> No. � Kitchen Exhaust�` duct recirculating �!7('j cfin <br /> No. � Bath Exhaust(must have duct outside) ��cfin <br /> No. Other Fans: Locations �� <br /> FITEL STORAGE (Must be approved by Fire Marshall if proposing to abandon tank in place.) <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: �_k� ��n./�,� <br /> 6 ' � <br /> 2 <br />