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�. <br /> . , * � <br /> SZ'S'�'ENb I)ESCI2IF�'�'lQ1V � <br /> HEATING SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> Fuel: <br /> Flue Size: <br /> Input BTUs: <br /> Output BTUs: <br /> CFM: <br /> CC10LI'NG S�'S'�'EMS <br /> Ouanti±y: __ ._ <br /> Make: <br /> Model: <br /> Tons: <br /> H. Power <br /> �'�I'.L�'�,A�'�S ��S I,Il'�F O:�rLY <br /> �� Cras factory fireplace ❑ Installing a Gas Line Only <br /> ❑ Wood burning factoiy firep;ace with flue <br /> ❑ Wood Stove <br /> ❑ ood stove with flue �' <br /> ���/��l:i�� ��1 S-;��,.v 6 �- l('� �"L/�c.r' <br /> Brand Name R�fodel Zdo. <br /> �I�Fd'�'����.'�'��?'vT <br /> No. _ ICitcl�en Exhaust duct recalc�.�latin� cfm <br /> No. Bath Exhaust (must have duct outside) cfm <br /> No. Other Far1s: Locations ���' � ;,: � �� <br /> ,;, � �«�: . ., . <br /> ;.�3r;. . ,:, .,- <br /> �'L1EI� S��F2��E (1VIUST BE APPROVED BY FIRE MARSHALj'�M. +wof'•�'a s � i��`.. <br /> �•��2 r�nr ���;;,,, ..:r <br /> °Zii•;..;>:4'. : <br /> ❑ Installation or ❑ Removal <br /> ❑ Ftiel oil: gallons ❑ underground ❑ inside ❑outside <br /> ❑ LP Gas: gallons <br /> ❑ Other Gas opening <br /> � 2 <br />