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� <br /> S�'S'E'G!t��3�SCRIF�'F'H�N � <br /> ��A'�'II`d� S''��'�'�1�5 <br /> �uantity: <br /> I�ake: <br /> �odel: <br /> Fucl: <br /> Flue Siz,e: <br /> Input BTUs: <br /> Output BTUs: <br /> cr-n�: <br /> �Qa�,�rv����s��;rv�s <br /> Quantity: _-- _ —_ __— <br /> I��ake: <br /> Moclel: <br /> Tons: <br /> H. .i'o��er <br /> F'��lE��°���;'�� �r.�S I,Ii`d� C��1�,�' <br /> [�1 Gas f`actory fireplace ❑ Installing a Gas Lane �3z�Iy <br /> ❑ Wood bunling factory fireplace witlz flue <br /> ❑ Wood Stove <br /> ❑ Wood stove witl�l flue <br /> �ra�.1d I�IaYrte�� ' _ ���odei 2�10. � <Se'.e,� <br /> ���1�?'�'F�_�hkrC'Ti�P�' <br /> I�o. i�itehen i;�;.haust duct recalc�iaT,in� efi�� _ <br /> l�ro. ____�Bath Exhaust (must have duct outside) efm <br /> ]�10. C��ther Fans: Locations .,,� �.,t �,j��,��� <br /> 9muN a Aft��M �bi�Mi Mb <br /> Q�AS t�OS lilf�li.1 <br /> ����� ��`'�3F��� (�UST BE l�.PPROVED B�'FIRE T�ARSHAL) �vA ws�v�iw� .N 00'�S <br /> �t r�NM,�NIrNeA <br /> ❑ Fnstallati.on or ❑ Removal '����t� <br /> ❑ F�iel oi?: gallons ❑ underb ound ❑ inside ❑outside <br /> ❑ LP Gas: gallons <br /> ❑ Other � Gas opening <br /> ' z <br />