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, - ti 1 <br /> � <br /> �1'S"�'E!V&IDIGSCRIP�'IQN . <br /> HEA�T'INC S�'ST�MS ': <br /> Quantity: I <br /> M ake: �i� IJ�D� ��.G�l_Gt%�Cl� <br /> Model: � �-�'�'K.-'�� �-�'�c�_ <br /> Fuel: �V I�VC�� / <br /> rlue Size: <br /> Input BTUs: J � " �CS� <br /> c�- r <br /> Output BTUs <br /> eF'v1: <br /> �ODLI',VG S4'STEIi'1S <br /> �uantity: _ <br /> Make: " <br /> Madel: <br /> 7'ons: <br /> i`H. Power <br /> � <br /> ; �'��2F�'I�.�C;�S ��_S I.��"d� C➢1�LY <br /> i � <br /> � Cas factory fireplace � ❑ Installing a Gas Liz�e C3nly <br /> �'ood burning factoiy fireplace with flue� <br /> � ❑ ��'ood Stove <br /> ❑ Wood stovc with liue <br /> Brand Name ?�Rodel 1�To. <br /> �'��T'�'����.'I'��?� <br /> No. Kitchen Lxhaust duct recalculatinb cfin <br /> No. Bath Exhaust(must have duct outside} cfm <br /> No. Other Fans: Locations cfm <br /> ��JLL S�'Q�I�AG� (MUST BE APPROVED BY FIRE MARSHAL) <br /> ❑ Installation or ❑ Re7noval � ;; nt•�„x:s <br /> ❑ Fuel oil: gallons ❑ underground ❑ inside t�o�`�side ` `'�` <br /> ❑ LP Gas: gallons � . .�.� . . �� ;,� : <br /> ❑ Other Gas opening � '�`.'" ``,''� ' <br /> � Z <br />