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03-16-' 15 13:51 FROM- T-612 P0002/0004 F-767 <br /> � <br /> � �I�y��1i^.�'.iw.it�Yl�4Ff�'ri�'�1¢�Ic�;.� 1-3�Y.�....��A��J=1�,t7.�1?��AY�t?t ��....'....1=�..�!:3:,��F�«+� .�z`'.r�.�*a��.0.y,����e.l`� 7�i,r.4n�7A ! <br /> Note: All Geothermal Systzms will r�ow reyuire a Site Plan cC Review by our Buildirrg Official. � <br /> �S THYS G�OT�Y�RMAY.? ❑Yes ❑No � <br /> � <br /> ��pTYNG S'YST�MS E <br /> Quantity: _ .,,�,,,,,.._� <br /> Make: <br /> Model: ..� .�_.w��__._._._—._. <br /> Fuel: . <br /> �lue Size; .�w�,_w ,w.,.,_ <br /> Input BTUs: _��,,, �___, <br /> Output BTC�s: � <br /> CFM: ��„ , <br /> COO�INC S'YST�MS <br /> Quantity: � <br /> Make: <br /> Model: <br /> � <br /> � <br /> Tons: ' <br /> r — ��, ._ �:.� ; <br /> I-I.Powcr Z <br /> FIREYLACES r 1,� <br /> �- d1��ea�-� - �1�;�� <br /> Gas Factory Fireplace Brand Name; <br /> ❑ Wood�urnin��'ireplace (`n�� � p"-' � <br /> �] Wood Stove Nladel No.; ( �1 � ��I_� <br /> ❑ Wood Stove with Plup/Masonry � <br /> VEIVTILATION <br /> ❑ N0. �Citchen�xhaust duct ��ecirculating _cfm <br /> ❑ No. Bath Exhaust(mtfst have duct outsidc) cfm <br /> ❑ No. Other f ans: Locations _ �w_�___ _ cfm <br /> �C1�I.,STORAC� (Must be approved by�Yre MarslrnCl if proposing to nbandort tank in place.) ! <br /> F <br /> i <br /> ❑ Installation ❑ RemovAl i <br /> I <br /> _ .. .._ Fuel�il; gallons ❑ [lnderground �Cnside []Outside � <br /> LP Gas� gallons ' <br /> Other: <br /> (CAS�YN�,4NC�Y <br /> � Outdoor Crill � Other/�,ist What&'�Vhere: M,,,�,���� <br /> 2 <br /> I <br /> j <br /> � <br />