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� �� <br /> Note: P,,11 G�otherz�aal Sysr.enls will z�ow r�qture a Sate Plan&12eview by our Buildiu�b Of�cial. <br /> IS THIS GEO'�'HERMAL? ❑ Yes ❑No <br /> FTEA'��;G SYSTE�IS <br /> Quantity: <br /> Make: <br /> Model: <br /> Fuel: <br /> k�ue Saze: <br /> Zzz�ut BTUs= <br /> Output B�'Us: <br /> CFM: <br /> COQL�'VG SYSTEI4�S <br /> Quantiry: _ __ <br /> Ma�ce: <br /> Model: <br /> Tons: <br /> H.PoweX <br /> k'�PLAC�S <br /> ❑ Gas k'actory Fireplace �xand Name: <br /> ❑ Wood Burni�ng k'i�eplAce <br /> ❑ Wood Stove �vlodel No.: <br /> ❑ �Vood Stove with Fluc/Maso�.ry � <br /> VENTILAT <br /> ❑ l�io. Kitck�ez��xhaust duct recztculating c�inn <br /> ❑ No, �ath�xhaust(zn,ust kzAve duet autside) �� <br /> ❑ No. Othez-�'a�as: LoCatioi�s cfnn <br /> FUEL STqR.A,GE„(�i3'ust be approved by F�re Marshull if proposing to[�bandott tank in plaee.) <br /> ❑ Installatioz� Q Rerr�pval <br /> Fuel Oi1: � gallons [� Uzxderground ❑Inside ❑ Outside <br /> L�Gas: gal�olus <br /> Ot�ei: <br /> GAS LINE QN�.Y <br /> � Outdoor Gz�il� � �tl�e7��/I,.isi What&UVk�ex-�: .�Tl�t�-r'P C.�yDr��� <br /> 2 ��'C //f� � <br />