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� CICAI I$ EM S BtNo s m._mm , ,- <br /> HEATING SYSTEMS <br /> Quantity: + <br /> Make: e 11 1'v-))( ell y11) y <br /> Model: w 1,1 /7—Iprx p3/ ( - 7C <br /> Fuel: tkir 1) G1 <br /> Flue Size: � <br /> Input BTUs: 1 ' ( 7 <br /> Output BTUs: q < <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> FIREPLACES <br /> Gas Factory Fireplace <br /> ❑ Wood Burning Fireplace <br /> ❑ Wobd".SStove <br /> O Wood Stove With Flue <br /> Brand Name: Model No.: <br /> VENTILATION <br /> No. Kitchen Exhaust duct recirculating cfm <br /> o. Bath Exhaust(must have duct outside) cfm <br /> ❑ No. Other Fans: Locations cfm <br /> FUEL ST:,,]RAGE(MUST BE APPROVED BY FIRE MARSHALL) <br /> O '"--,Installation ❑ Removal <br /> Fuel Oil: _ gallons 0 Underground 0 Inside ❑Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill ❑ Other/List What&Where: <br /> 2 <br />