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Note: A,�l Geotherma� Sys1�ems will z�ow require a� 't Plan&Rev�ew by our Bui�diulg Officia�_ <br /> ZS THIS GEO�'�TERMAL? ❑Yes ❑No <br /> HEA'�T.I�TC SYSTEMS <br /> Quantity: <br /> Make: <br /> Model: <br /> F�tel: <br /> F1ue Size: <br /> Z�put BTYJs: <br /> Output BTUS: <br /> CFM: <br /> CQOLIN'G S�'STEMS <br /> Qua�.tity: <br /> Make: <br /> Mode�: <br /> Tons: <br /> �.Pawer <br /> PT,ACE <br /> � C'7as k'actory�irep�ace Brand Name: CON7IN�NTA�. <br /> ❑ Wood Bu,n�izzg Fu�epiace <br /> , ❑ Wood Stove Model No.: CB42 <br /> � Wood Stove with Flue/Masozuy <br /> VENTILA'z'��N <br /> ❑ No. Z{xtck�en Exhaust duct recirculatiu�g _ c� <br /> ❑ No. Bath Bx�aust(xn.ust have ducr outside) �� <br /> ❑ No. Otk�e�•�'ans: Locatxo��s `���, <br /> k'iT�L STO E (Must be ap,�roved by F�r¢,Marshall if praposin�to abanrlon tank in plrrce.) <br /> ❑ Insfallation � �ezaovaI <br /> Fuel 0i1: ga�loz�s ❑ Undei�ground ❑ Zz�side ❑ Outszde <br /> �,P Gas: �gallons <br /> Othe�: <br /> GAS�,INE ONLX <br /> ❑ Outdoa�Grzll � Ot�,er/List Wk�at&Where: GAS L1NE Tp FIREPLACE <br /> 2 <br />