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48/13/2014 arEo 10: 35 FAx 763 �73 8565 6nbre Hedting & air Cond f�006/047 <br /> Note: A11 Geothermal Systems will now require�Sit��c�Review by our$uildtng Off"icial. <br /> IS THIS GEUTHEIiMAL? ❑Yos [,�No <br /> HEATING SYST�M9 <br /> Quantity: _____�_ <br /> Malca: <br /> �a�t: 3+�ot�ix2��7b <br /> Fu�: N�� _ •P�� <br /> �ua s«: 3 � <br /> Ynput BTUs: � 0 d _,_,���d�0 <br /> Output BTUs� <br /> CFM: � O - <br /> CUOLING�SYS'l'�MS <br /> Quautity: � <br /> MHke: - <br /> Model: .r. <br /> Tor�s; '�J�vM _ <br /> H.Power .. <br /> kI$EPI.ACES <br /> � ❑ G�s Factory nireplace Brand Nama: <br /> ❑ W�d�urning Fireplaca <br /> 0 Wood Swve Modei No.: <br /> � Woad Stova with Ftue/l�asonry <br /> V�NTILA�'IQ1Y <br /> � No. �� iCitohen Exhaust _ duct reCirculatit�g b b cfm <br /> No. �_ aath Exhaust(must hava dud autside) 0 cfm �^$QG� <br /> 0 No. � Other Fans: l.ocations �� <br /> �`CIEL 8a�(Mr�t be�p,proved by FYre Marslia!!ifprnparing fo abandr►n la�nk!n plac�) <br /> 0 Installation ❑ Romoval <br /> , Fuel dil: ___gallons ❑ Underground ❑lnsida ��utside <br /> LP Gas: gailons <br /> Other; <br /> GAS LINE ONLY <br /> ❑ Dutdoor Grill [) Other/List'UVhat&W�,ere: <br /> 2 <br />