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� <br /> Note:All Geothermal Systems will now require a i P &Review by our Building Official. <br /> IS THIS GEOTHERMAL? ❑Yes [�io <br /> HEATING SYSTEMS <br /> Quanrity: <br /> Make: <br /> Model: <br /> Fnel: <br /> Flue Size: <br /> Input BTUs: <br /> Output BTUs: <br /> CFM: <br /> COOLING SYSTEMS <br /> Quantiry: <br /> Make: <br /> Model: <br /> Tons: <br /> H.Power <br /> �3FP�cES <br /> ❑ Gas Factory Fireplace Brand Name: <br /> ❑ Wood Burning Fireplace <br /> ❑ Wood Stove Model No.: <br /> ❑ Wood Stove with Flue/Masonry <br /> VErTTILATION <br /> 4 <br /> ❑ xo. 1 ��n���t G au�c ���g 3°� �� <br /> ❑ No, ( Bath Exiiaust(must have duct outside) S� cfin <br /> ❑ No. Other Fans: Locations cfrn <br /> FUEL STORAGE (Mtest be approved by Fire Marshell if proposing to abandon tank in plac�) <br /> ❑ Installarion ❑ Removal <br /> Fuel Oil: gallons ❑ Underground ❑Inside ❑Outside <br /> LP Gas: gallons <br /> Other: <br /> GAS LINE ONLY <br /> ❑ Outdoor Grill � Other/List What&Where: �'S I�^'` � Cclvtc�or <br /> 2 <br />