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_ � <br /> � , <br /> SS'STEM DESCRIPB'lON � � <br /> 1H[�ATING S'fISTEIVflS <br /> Quantity: <br /> Make: <br /> Model: <br /> Fuel: <br /> Flue Size: <br /> Input BTUs: <br /> Output BTUs: <br /> CFM: <br /> COOLING Sl'STEIV�S <br /> Quantity: __ — <br /> Make: <br /> 1�lodel: <br /> Tons: <br /> H.Power <br /> ����:�L�e�s �.�As �,��r� a��.iT <br /> ❑ Gas factory fireplace � ❑ Installing a Gas Lane dnly <br /> � Wood buming factoiy fireplace witli flue <br /> ❑ Wood Stove <br /> ❑ Wood stove with flue <br /> Brand Name ��s Model No. �(oO � �� ���v � <br /> ��lee''T����.�'I�9N <br /> No. ICitchen Exhaust duct recalculating cfm • <br /> No. Bath Exhaust (must have duct outside) cfm <br /> No. Other Fans: Locations ,ant:raM�:r.rt:�df+�n:vr�. x �s+,se+ <br /> h�riOH �S i���eSR1- .�r., �>>i? �:�; <br /> JAOS!c'�3;; yPr:.�i <br /> �'�TLL S�'ORAGE (MUST BE APPROVED BY FIRE MARSHl��:�r�;v�is7 ..N ��+:r5. <br /> F r r�NM,Nlr►�aoa <br /> ❑ Installation or ❑ Removal t�x-�1«� <br /> ❑ Ft�el oil: gallons ❑ underground ❑ inside ❑outside . <br /> ❑ LP Gas: gallons <br /> ❑ Other Gas opening <br /> � 2 <br />