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05-17—'17 15:26 FROM— T-218 P0002/0404 F-484 <br /> . � <br /> � N'ote:All Geothern�al S�stems will noW require a Site�'lan�.Review by our Building Off'icial_ <br /> IS THIS GEOTHERMAL? 0 Yes ❑No <br /> HEATING SYSTEMS <br /> Qlt8nti��: <br /> Make: <br /> Model: <br /> Fuel: <br /> Fluc Size: <br /> Ynput B'T'C.Ts: <br /> Output�TCls: <br /> CFM� <br /> COO�.yI�G 8'i'STE1vYS <br /> QuantitY= <br /> Make; <br /> Modzl: <br /> Tons: <br /> H_Power <br /> �'YREPLACES <br /> `� Cras�actory Fireplaee� �rand Name: 1 _ <br /> 'Wood Burning Fireplace <br /> ❑ Wood Stovc Model No.: c�L� � ��� <br /> ❑ 'Wood Stove with Plue/Masonry <br /> 'VIENT]IX.A'X'YON <br /> ❑ No. Kitehen Exhaust duct recii�culating cfm <br /> ❑ N'o. �ath Exhaust(must have duct outside) cfm <br /> ❑ No. Other�'ans: Locations c�'aa <br /> �Y1�L STOYtAG� (Mt�st be npproved by Fire Marshall if proposing to abmrdon tank in plac�) <br /> ❑ Installation ❑ Remo'vAl <br /> �uel Oil: �allons [� Underground �Xnside ❑Outside <br /> �,P Oas: �,gallons <br /> Other: <br /> (CA,S Y,�IVE ONLY <br /> ❑ Outdoor Grrill ❑ Other/List What&'UVhere: <br /> 2 <br />