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� � �R � <br /> S`�'S'�'��4'�BES��IiA'�'IQIV � <br /> I��A�'I,'°r'C;S�'S`E"�11�5 <br /> Quantity: <br /> lvlake: <br /> l�lodei: <br /> c <br /> Fuel: <br /> Flue Siz.e: <br /> Input BTUs: <br /> �utput BTUs: <br /> CFM: � <br /> �C30E,�TV���.'S'�'�!V�S <br /> Ouanti±.: <br /> I�Rake: <br /> 1Vtadcl: <br /> Tons: <br /> H.l?ower <br /> Ei��.�S��RJ.�.�f:/1.3 �:�� �J��'�VLi �LYI�Y <br /> � Gas factory fireplaee X �-- ❑ I�zstalling a C3as Lzne �Jrly <br /> ❑ VJood burnin�faetozy freplaee wit1� 17ue <br /> ❑ ��ood Stove <br /> ❑ �,�%ood stov�;witI�i flue <br /> Bra�.zd P��ame�� � �: I��odel No. �rJO��� <br /> �'�I�"�'r��I�.�'���' <br /> l�io. I:itcl�en ExhaL�st duct �recalci.�latin� e�in <br /> I�o. __ ___Bath Exhaust (must have duct outside} cfm <br /> ]`10. _ Gther Fans: Locations cfm <br /> ��'��. S'�'���.�E (iViUST EE f�t'�r'�QVFD BY FIRE MARSF-iAL) <br /> ❑ Installation c�r ❑ Reznoval <br /> ❑ Ft�el oil: gatlons ❑ underground ❑ inside ❑outside <br /> ❑ LP Gas: gallons <br /> ❑ Other '__��m___ Gas opening <br /> � � <br />